Mentoring Circles Program: Mentor Application
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First Name *
Last Name *
Email *
BWH email address (will not be shared outside the MCP)
Gender *
Required
Nationality (type in N/A if prefer not to disclose) *
Race *
Highest Degree *
Department *
Lab / Group *
PI's name
Laboratory location *
When did you start your postdoc at BWH? *
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/
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YYYY
How long have you been a postdoc? *
Please indicate time at BWH plus potential postdoc times at other research institutions.
Have you previously participated in the Mentoring Circles Program? *
Do you have a significant other also applying for the Mentoring Circles Program? *
If yes, please provide their name below. If no, put N/A.
How much experience do you have in the following fields? *
0
1
2
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4
>4
Number of Publications
Number of First Author Publications
Number of Awarded NIH Grants
Number of Foundation Grants
How do you rank your knowedge in the following categories? (This question allows us to match you with the right mentors and mentees and to evaluate your progress at the end of the program) *
1 = no experience, 5 = expert
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2
3
4
5
Academic Job Track Issues
Paper Publishing
Grant Writing
Biosketch/CV Writing
Teaching
Career Development in Medicine
Development of Career Skills
Communication Skills
Transition to Industry
Exploring Alternative Careers
Interviewing Skills
Informational Interview
Resume Writing
Cover Letter Writing
LinkedIn
Networking
Work/Life Balance
What do you want to learn at MCP? (This question allows us to match you with the right mentors and mentees) *
1 = not interested, 5 = very interested
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2
3
4
5
Academic Job Track Issues
Paper Publishing
Grant Writing
Biosketch/CV Writing
Teaching
Career Development in Medicine
Development of Career Skills
Communication Skills
Transition to Industry
Exploring Alternative Careers
Interviewing Skills
Informational Interview
Resume Writing
Cover Letter Writing
LinkedIn
Networking
Work/Life Balance
What career path(s) interest you? *
1 = not interested, 5 = very interested
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2
3
4
5
Academia (Research)
Academia (Teaching)
Industry
Scientific Writing
Government
Clinical practice
Consulting
Patent law
Entrepreneur 
Where do you see yourself in 2-3 years? *
Which meeting format do you prefer? *
How did you hear about MCP? *
How often do you want to meet with your circle? Select all that applies.
As a mentor, what do you think you can contribute to the mentoring circle? *
Acting as a mentor in the BWH Mentoring Circle Program (MCP) requires commitment to: 1) dedicating a minimum of 2-3 hour-session per month over the academic year (September 2023-June 2024); and 2) attending the required MCP events such as the MCP Kick-Off (October 2023) and the BWH Mentoring Celebration (May 2024). Please type in your full name below to indicate that you have understood these requirements.
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