Association of Women in Science Mentoring Program - Protegee Form

The Palo Alto Chapter of the Association for Women in Science cordially invites all female graduate students and post-docs in science and engineering to participate in the Association for Women in Science Mentoring Program, which consists of:
- Five meetings during the academic year with dinner and a talk or panel discussion on work-life balance, interviewing skills, academia versus industry, communication skills, etc..
- Grad students and post-docs are paired with a scientist/engineer volunteer mentor who is working in academia or industry to provide one-on-one mentoring.

* Required

Personal Information

First Name *

Last Name *

Email Address *

Phone Number

Street Address (mailing)

City

Zip Code

Scientific Career

Department *

Graduate Student or Post-Doctoral Affiliate/Fellow? *

Graduate Student
Post-Doctoral Affiliate/Fellow

Scientific interests * (field/discipline and specific area of interest)

Degrees obtained (major, school, date)

Career experience (job function, industry, years of experience)

General Mentoring Program Information

Did you participate in the mentoring program last year?

If you would like the same mentor as last year, please list her name:

If you are a post-doctoral research affiliate/fellow, would you also be willing to mentor a graduate woman in science? (if yes, please fill out the mentor form as well: http://spreadsheets.google.com/viewform?formkey=dGljZTRETWVsb3RrWGlSanRqQUZkVVE6MA..)

If you are a senior graduate student, would you also be willing to mentor newer graduate student? (if yes, please fill out the mentor form as well: http://spreadsheets.google.com/viewform?formkey=dGljZTRETWVsb3RrWGlSanRqQUZkVVE6MA..)

Finding a Mentor Match

Would you be interested in having a senior graduate student as a mentor? *

Would you prefer to have a mentor who works in academia or industry? *

Academia
Industry
Either

Choose the MOST important subject that you hope to discuss with your mentor * (select one)

Choose the SECOND most important subject that you hope to discuss with your mentor * (select one)

Choose the THIRD most important subject that you hope to discuss with your mentor * (select one)

Other subjects that you hope to discuss with your mentor:

Feel free to tell us more about what you’re looking for in the mentoring experience:

Additional comments or questions:

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Association of Women in Science Mentoring Program - Protegee Form

Personal Information

Scientific Career

General Mentoring Program Information

Finding a Mentor Match

For more information, email mentoring_awis@yahoo.com or visit: http://www.pa-awis.org/activities/Mentoring/ment_protege.htm