Mentorshoppe – Mentee Application

Submission Instructions

  1. Please read the Mentorshoppe Policy and Procedures prior to completing the application.
  2. Upon completion of the form below, please click on the “Submit” button.

All questions/concerns about the Mentorshoppe Program should be directed to the Mentorshoppe Coordinator, Dr. Amy Van Arsdale, at

S/ECP Mentee Application 2019

  • Required Information

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

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

  • Optional Information:

    • Career advancement
    • Marketing
    • Business of practice
    • Professional identity development
    • Leadership development
    • Work-life balance
  • 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.
    • Mentor lives in same geographic region
    • Mentor shares the same sexual orientation
    • Mentor shares the same ethnicity
    • Mentor shares the same gender
    • Mentor shares the same religious/spiritual affiliation
  • 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.