Mentee Applicant Questionnaire for 2025 ANR Mentorship Program

✻ = Required

Are you a staff or academic employee? ✻

Staff Academic

First and Last Name ✻

Email address - please double check for accuracy. ✻

Phone # ✻

Unit ✻

Payroll Title ✻

Working title ✻

Number of years with UC ANR. ✻

Less than 1 1-2 3-5 6-10 11 or more

Number of years in current position ✻

Less than 1 1-2 3-5 6-10 11 or more

Supervisor's name ✻

Supervisor's email ✻

Supervisor's phone # ✻

Provide a basic description of your work experience at UC ANR. ✻

What are 1-2 professional goals you have for participation in the Mentorship program? ✻

Why are you a good candidate for this mentorship program? ✻

Please check the boxes to acknowledge your commitment if selected for the Mentorship Program: ✻

I understand that the criteria for participation in this 9-month program includes participation in monthly meetings with my mentor and three in-person group sessions (Orientation Strength Finder session Debrief/Celebration) and that it is my responsibility to make arrangements for finding time to participate in this program. It is my responsibility to communicate my interest in this program to my supervisor/manager seek their approval and work with them to fit this program into my work schedule. I WILL communicate to my supervisor attendance to in-person events

Describe what you think your responsibility(ies) might be as a Mentee in a Mentoring relationship. ✻

Other comments you'd like to share with the mentee selection committee (optional)?

General comments?

Show us you are not a robot by entering this code: 4MENTOR ✻

My Supervisor approves of my application to this program. ✻

Yes No