Mentor Application - 2024-2025 UCLA Fielding School of Public Health Mentorship Program

Thank you for signing up to be a mentor! Your willingness to share your time, expertise, and experiences with our students and recent graduates is invaluable. Your generosity not only strengthens our community but also inspires others to give back in meaningful ways. We deeply appreciate your commitment and are excited about the positive impact you will have as a mentor!

Please complete this application for the 2024-2025 Alumni-Student Mentorship Program.

If you are a student and would like to apply as a mentee, please apply here.

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* 1. First Name

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* 2. Last Name

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* 3. Student ID (leave blank if you don't remember)

We are working hard to make our school a more diverse, inclusive, and equitable community that invests in and uplifts our diverse students, faculty, and staff. Therefore, we will be incorporating demographic questions to help with our matching process. Please only respond if you are comfortable.

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* 4. Do you identify as a first generation college student?

Yes

Prefer not to answer

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* 5. Please indicate your personal pronouns. Read more about pronouns here. Your response to this question is optional. This will be shared with your mentee.

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* 6. In an effort to support our international student population, we would like to include an option to be matched with an alumni mentor that has a similar background and/or educational experience. If you are interested in being matched with an international student specifically to share your own experience as a grad student, resources, using OPT/CPT, getting employer sponsorship, etc., please indicate so below.

Yes

If yes, please list your country of origin.

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* 7. Preferred Email

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* 8. Preferred Phone

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* 9. Linkedin Profile

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* 10. Where do you live?

City

State

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* 11. Which industry did you/do you work in?

Academia/Education

Administration and Management

Behavioral Health and Social Sciences

Consulting

Environmental Health

Epidemiology

Global Health

Government/Public Policy

Hospital/Health

Marketing, Public Relations, or Communications

Nonprofit (which includes Foundations, NGOs)

Self-Employed

Pharmaceutical, Biotech or Medical Devices

Research/Post-doc/PhD

Other (please specify)

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* 12. Are you retired?

Yes

Mentor Application - 2024-2025 UCLA Fielding School of Public Health Mentorship Program

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* 1. First Name

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* 2. Last Name

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* 3. Student ID (leave blank if you don't remember)

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* 4. Do you identify as a first generation college student?

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* 5. Please indicate your personal pronouns. Read more about pronouns here. Your response to this question is optional. This will be shared with your mentee.

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* 7. Preferred Email

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* 8. Preferred Phone

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* 9. Linkedin Profile

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* 10. Where do you live?

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* 11. Which industry did you/do you work in?

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* 12. Are you retired?

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* 13. Where do you currently work? (If retired, where did you work before you retired?)

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* 14. FSPH degree

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* 15. Graduation year

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* 16. If you were in a joint degree program, please specify which program

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* 17. If you have any additional degrees please list them here:

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* 18. Have you participated in the Mentorship program before?