ACVP Student Mentorship Program Mentor Enrollment Form
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I Would Like to be a Mentor
First Name
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Enter your first name.
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Last Name
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Enter your last name.
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Email Address
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Enter the email address associated with your ACVP membership account.
This field is required.
General sector of employment
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Select all that apply.
Academia
Corporate/ Private
Government
Military
Self-Employment/ Consulting
Other
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If ‘Other’, please specify
Specify sector if not listed above.
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Are you retired?
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Specify if you are retired.
Yes
No
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ACVP membership category and area of specialization
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Select your membership category and specialization area. Only current active ACVP members may apply.
Anatomic Pathology Diplomate
Clinical Pathology Diplomate
Anatomic & Clinical Pathology Diplomate
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Additional certifications
List any additional relevant certifications.
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In which of the following areas can you provide mentorship:
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Select all that apply.
Well-being
Giving/receiving feedback
Communication skills
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How many veterinary students would you be willing to mentor this cycle if needed:
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One
Two
Three
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Please tell us any additional information that may be useful in matching you with a potential mentee:
By submitting this form, I commit to the ACVP Veterinary Student Mentorship Program for the 6-month duration. I will:
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Meet at least six times in the 6-month period
Have a genuine interest in and commitment to the program
Be objective, honest, and supportive
Act ethically and with respect towards all participants
Respect and maintain strict confidentiality
Contribute to discussion and attainment of goals raised in meetings
Complete the program post-evaluation
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I acknowledge that either mentorship partner has the right to discontinue mentorship for any reason, and we will follow the Early Mentorship Closure procedure.
*
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Submit
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