Application

Junior Scholar Seeking a Mentor

Commission on the Status of Women (AEJMC)
Mentoring Project
[Note: The information you enter on this form will be shared only with the person who becomes your mentor.]

Name _______________________________________________________________________
University _____________________________Communication Area(s)____________________
Email _____________________________________ Telephone _________________________
Academic status:
____
____
____
____
____

Doctoral student (if so, expected graduation: _____)

Lecturer or instructor
Assistant Professor
Associate Professor
Other _________________________

Demographics:

Nationality:
_______________________________________
Race/ethnicity: ______________________________________
Age: ______________________________________________
Other (e.g., physical ability, sexual orientation, etc.) _____________________

What motivates you to seek a mentor? (Check all that apply)

____
____
____
____
____

Strengthen my scholarship
Strengthen my teaching
Evaluate my strengths
Strategize my job search
Talk about tenure

____
____
____
____

Talk about promotion

Deal with a specific situation
Adjust to (non)diverse campus environment
Other ______________________________

Attributes and experiences you seek in a mentor (check all that apply):
____
____
____
____
____
____
____
____
____
____
____

Is a full professor
Experienced and survived discrimination
Is a strong scholar
Is a woman of color (specify: ______)
Is a White woman
Is close to my age
Is older than I am
Has the same comm.. specialties as me
Holds an administrative post
Has experienced sexual harassment
Is a woman

____
____
____
____
____
____
____
____

Is a man
Is married/has been married
Has children
Is single
Is a sexual minority
Has been a leader in AEJMC
Other __________________
Other __________________

Time and other commitments you seek:

____
____
____

Periodic telephone consultations: ___ once a month

___ twice a month
Review of applications and/or other materials
Other: _______________________________________________________

___ three times momth

Do you have someone in mind to serve as your mentor? If so, who?_______________________

Please return form by email either to Tracy Everbach, Everbach@unt.edu, or Frances Ward-Johnson,
fward2@elon.edu, by October 25, 2013.