Physical Sciences Mentorship Program Application - Winter 2023
Application for Mentors
Find more information: https://center.ucsd.edu/mentor-village/mentorship-program

Deadline to apply is Monday, October 31st!
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First Name *
Last Name *
Email address *
Salutation *
Mr., Mrs., Ms., etc.
Phone *
Location *
LinkedIn URL
Gender (optional)
Race/Ethnicity (optional)
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Highest Degree Level Achieved *
What was you college major? What degree(s) do you have? *
UC San Diego Alumn? *
First Generation College Student *
Have you participated in the Physical Sciences Mentorship Program in the past (either the Pilot Program or in Winter 2021)? *
Where do you currently work? *
What is your professional job title? *
How many students are you able to mentor *
Do you prefer to work with students from certain major(s)? *
Required
Do you know what degree level your company is interested in for INTERNSHIP opportunities? *
Required
Do you know what degree level your company is interested in for FULL-TIME EMPLOYMENT opportunities? *
Required
I can provide mentoring to students on the following topics *
Required
Is there anything else you would like us to consider?
Type your full name if you have read the Winter 2023 Mentor-Mentee Agreement: https://docs.google.com/document/d/1JjQPpoCKqjdbgQVOCmDgrZZT8M8LM-Vv/edit?usp=sharing&ouid=102927167768625810737&rtpof=true&sd=true *
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