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Mentor Enrollment Form for NCSSM Durham Mentorship Program (2024-2025)
Thank you for your interest in NCSSM Mentorship! It is the 43rd anniversary of Mentorship at NCSSM and we would love for you to join this long standing tradition of engaging the next generation. To learn more about the NCSSM Mentorship program visit the
Mentorship Program
and
Durham Prospective Mentors
pages of the Research & Innovation website.
Please complete this Mentor Enrollment Form if you would like to:
offer an opportunity
in Summer or Academic Year Mentorship 2024-2025
finalize your mentee match
by submitting the required opportunity details
communicate your unavailability for this year
but remain on the list for future years
remove your name
from our contact list
express interest
in becoming a mentor
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to save your progress.
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Email
*
Your email
Join Us as We Engage Thinkers, Makers, Doers of the Next Generation
Preferred Title (Dr., Mr., Mrs., Ms., Mx, Prof.)
*
Dr.
Prof.
Mr.
Mrs.
Ms.
Other:
FIRST
Name
*
Your answer
LAST
Name
*
Your answer
What is your anticipated mentor status for 2024-2025?
*
I have been matched with a student(s) for 2024-2025
I am offering an opportunity for a Mentorship student to engage in an ongoing or independent research project for 2024-2025.
I am interested but do not anticipate being able to participate in the program for this year but would like to receive communication from the program in the future.
I am interested and want to learn more about NCSSM mentoring opportunities.
I do not anticipate being able to participate in the program going forward.
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