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CHAMP (Chronic Health Allies Mentorship Program) Mentor Form_Fall 2020
Feel free to email
uwmadisonchamp@gmail.com
with any questions.
Please note that due to COVID-19 CHAMP events will be held virtually for the foreseeable future.
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* Indicates required question
What is your name?
*
Your answer
What is your email?
*
Your answer
Which graduate program are you in?
Your answer
If you feel comfortable sharing, what kind of challenges did you face in undergrad with regard to your chronic illness, pain, or disability and how do you think you will be able to use those experiences to help mentor undergrads? (3-5 sentences)
Your answer
Why do you want to be a mentor? (3-5 sentences)
Your answer
What are your hobbies/interests?
Your answer
Are you willing to commit to one training, one semesterly event, and meeting your mentee once per month?
Yes
No
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