2024 NASSS Chicago Mentor Sign Up Form 
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First Name  *
Last Name  *
Email  *
Briefly describe your experience working on issues including, but not limited to, equity, diversity, and inclusion
*
Briefly outline experience providing mentorship
*
Can you commit to attending all of the pre-conference activities and supporting junior scholars after the conference?
*
Do you hold a PhD?
*
Current institutional affiliation
*
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