2020 Georgia CTSA Mentoring Program: Mentee Application I. Candidate information Question Title * Name: Question Title * Email address: Question Title * Phone number (please provide the number that you can best be reached) Question Title * What is your Georgia CTSA affiliation?Program is only available to trainees and faculty at Georgia CTSA partner institutions. Emory University Georgia Institute of Technology Morehouse School of Medicine University of Georgia Question Title * What is your current academic position? Instructor Assistant Professor Post-Doctoral Clinical Fellow Other (please specify) Question Title * How long have you been in your current position? Year(s): Month(s): Question Title * Current Time Allocation %If time allocation is 100% in one area, enter 0 in remaining sections. Clinical Research Teaching Administration Other (please describe) Question Title * What is your academic discipline? Question Title * Please provide a two sentence summary of your research. Next