S/ECP Mentee Application

Submission Instructions

  1. Please read the Student/ECP Mentorshoppe Policy and Procedures prior to completing the application.
  2. Upon completion of the form below please click on the submit button below.

All questions/concerns about the S/ECP Mentorshoppe Program should be directed to the S/ECP Mentoring Coordinator Dr. Lindsey Buckman at buckmanconsulting@gmail.com

S/ECP Mentee Application

  • Required Information

  • First and Last Name Please
  • Click calendar and the date picker will open.
    Click all that apply
  • Date Degree Received (if applicable)

    If you have received your degree, please select the month and year you received it.
  • If Applicable

  • Optional Information:

    Check any that apply
  • What other factors should we take into consideration in order to create a constructive match? Please review the list below and, based on your stated factors, preferences, and available mentors, drag the choices below into the order of preference - with the first being your most important. If you do not have a preference please skip to the Agreement section below.
    • Lives in same geographic region
    • Shares the same sexual orientation
    • Shares the same ethnicity
    • Shares the same gender
    • Shares the same religious/spiritual affiliation
    Rate the choices above in the order fo importance.
    Please Check all that Apply
  • Agreement

  • By typing my name and today’s date in the fields below and clicking submit, I acknowledge that I have read and that I agree to Division 42’s S/ECP Mentorshoppe Policies and Procedures.