UA Phoenix Med
Faculty Mentoring Program - Mentor Profile
Part 1
Please fill in the fields below to submit your information for the Faculty Mentoring Program
Name
*
First
Last
Email
*
Phone Number
*
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Faculty Title
Degrees
Specialty/Fields
My Career Interests Include (select all that apply)
Teaching
Patient Care
Administration/Other Services
Other
If Other, Please Explain Below
Please List Your Institution(s), Roles, Activities, and Percent Time. (Example: UA COM-P, CBI Facilitator, 10%).
Attach a Copy of Your CV (Optional)
What I Hope To Gain From This Experience
Faculty Mentoring Program - Mentor Profile
Part 2
Please indicate the content areas you would be willing to mentor in below
Teaching
(Curriculum development, Feedback/Evaluation)
*
Yes
No
Scholarship
(Manuscript Writing, Presentations)
*
Yes
No
Research Methodology
(Statistics, Quantitative, Qualitative)
*
Yes
No
Grant Seeking / Writing / Reviewing
*
Yes
No
Balancing Professional and Personal Roles
*
Yes
No
Leadership
*
Yes
No
Negotiation and Conflict Resolution
*
Yes
No
Clinical Trials
*
Yes
No
Professionalism
*
Yes
No
Community Health Issues
*
Yes
No
Program Development, Implementation, and Assessment
*
Yes
No
Professional Ethics
*
Yes
No
Humanities and Medicine
*
Yes
No
Other Areas of Interest/Expertise You Would Like to Explore?
Do Not Fill This Out