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* 1. Contact Information

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* 2. I am most interested in receiving mentorship in the following areas:

  1. Academic Affairs - Academic Planning / New Program Development and Implementation
  2. Academic Affairs - Accreditation / Outcome Assessment / Program Evaluation
  3. Advancing DEI
  4. Budget and Finance
  5. Clinical and Community - Clinical Practice Development/Contract Negotiations
  6. Clinical and Community - Community Engagement
  7. Human Resources - Organizational Structure / Succession Planning
  8. Human Resources - Personnel Management / Reappointment, Promotion, and Tenure
  9. Leadership - Crisis Management / Change Management
  10. Leadership - Managing Relationships / Team Building / Communication
  11. Managing Student Expectations
  12. Navigating Academic Health Center Environments
  13. Space / Resource Allocation
  14. Strategic Planning
  15. Other - please detail below

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* 3. Please detail other area(s) that you are interested in receiving mentorship.

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* 4. Additional Questions/Comments