Last name: (*)
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First name: (*)
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Please check all that apply: (*)
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Choose one: (*)
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Email address: (*)
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Home address: (*)
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Primary phone: (*)
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Secondary phone:
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What is the best and 2nd best way (email, cell phone call, cell text) to reach you?
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Current profession and area of specialty: (*)
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Employer: (*)
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Location in which you would like to mentor (city, state): (*)
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Type/s of mentoring you could provide (check all that apply): (*)
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Do you have a preference to work with: (*)
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Are you interested in accepting more than one student at a time?: (*)
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Please write a short, 1-paragraph biography introducing yourself to your mentee. This bio should include your educational, professional, military, and collegiate background (include titles, organizations, location, dates, degrees, etc) as well as any personal information you want to provide: (*)
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