Mentorship Request

AGE-SW is excited to offer gerontology-specific mentoring from national scholars to current AGE-SW members who are graduate students. The goal of the mentorship program is to connect students with gerontological social work scholars and practitioners. Mentors do not function as a second advisor or committee chair; rather, they seek to provide additional support to students. If you are seeking a mentor for particular tasks, we invite you to complete this form so that we can begin the matching process for you. Thank you!

Name*
First Last
Preferred contact (email or phone)*
- Phone
- Email
Email*
Phone*
What is the name of your university and what program are you in (MSW/PhD)?
What year are you in your program?
Please describe your career goals over the next 5 years.
Please describe your immediate learning goals.
Please write a short description (3 to 5 sentences), detailing your reasons for seeking a mentor.
Being as specific as possible, list what you would like to gain through this mentoring relationship.
How long would you like to be engaged in this mentorship relationship?
How much time would you like to spend with your mentor (i.e., one time contact, ongoing contact)?
What is the best way to communicate with your mentor?
Is there anything else that you want to tell us that would help us match you with a Mentor?

Mentorship Request

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