MCB Professional Mentor Registration Form

School of MCB Professional Mentor Registration

Thank you for your interest in being a mentor to students in biology, biochemistry and molecular and cellular biology (MCB) at the University of Illinois Urbana-Champaign. Please fill out this registration form, so we can use it to make appropriate matches with our students and ensure we have the most accurate information. Mentorship matches are typically made between students and alumni each fall. We anticipate that the pairing will last at a minimum through August of the following year.

If you have any questions about the program, please refer to our website or contact Tina Knox at tmknox@illinois.edu or 217-244-8282.

1. Full name as you would like to be listed and introduced to our students.

2. Primary email address (preferred contact address) answer must be an email address

3. Secondary email address. Only fill this in if you want us to have an additional contact address. answer must be an email address

4. Primary phone number. Note this will not be given to students without your permission. It will simply be used as a way for the program coordinators to get in touch if email is not proving to be efficient. answer must be phone number with area code like 217-333-1000

5. What is your current job title?

6. What is your current place of employment. Please include the city and state, as this will help with matches.

7. How many students will you have the ability to mentor this year?

Other

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8. Do you anticipate being able to offer in-person shadowing opportunities or site visits for your mentees?

Yes

Maybe

Other

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9. Please list your degrees, including any undergraduate and any graduate and/or professional degree(s), along with the graduation year and university.

10. Optional: Please consider uploading a short biography or outline of your time from your UIUC graduation to your current position. We use these when advertising talks and panels that you might participate in. They also come in handy when making matches. (maximum file size: 15MB)

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11. Optional: Please consider uploading a picture that we can use when advertising any talks or panels you participate in. We will not post your picture without your permission. (maximum file size: 15MB)