Instructions:

Please copy each of the numbered items below into the Application Field and enter your responses beneath.



1.  Department.
2.  Box No./Phone.
3.  Position Title.
4.  Time in Department.
5.  Time at University of Washington.
6.  Why are you interested in a mentoring relationship?
7.  Is there any information you would like us to take into account in matching you with a mentor?
8.  Would you like to list your top three choices for a mentor?  If so, please visit the biographies 
section of this website to assist you. Before making a mentor request, please consider the 
following guidelines for an effective mentoring match. It is not advisable to request a direct supervisor. 
Confidentiality is important in a mentoring relationship; therefore it is not advisable to request anyone 
in your department. Consider the job skills and compatibility of the mentor. We will take your requests
into account during the matching process, with the final match approved by both mentee & mentor.
9.  By submitting this form, you attest that you have discussed your participation in this program with
your supervisor. Please enter your supervisor’s name.

Application Field