Toggle navigation
CSEB Application Form for Mentors | SCEB Formulaire de demande pour les mentor
Home
Application
Language
English
Français
1
Begin Application
2
Confirmation
First Name
Last Name
Email Address
How would you describe your gender?
How would you describe your race/ethnicity?
What is your preferred language
Please select
English
French
Discipline (please select)
Please select
Epidemiology
Biostatistics
Other (please specify)
If other please specify
Career stage (please select)
Please select
Early career
Mid-career
Late career
Other (please specify)
If other please specify
Work setting (please specify)
Academia
Industry
Public health
Clinical setting
Other (please specify)
If other please specify
Institution
Research interests (please provide up to 5 keywords)
What are you hoping to contribute as a mentor?
Please select
Career growth
Technical skills
Leadership experience
Industry knowledge
Networking
How long do you want to be involved in the mentorship?
Please select
1 year
2 years
3 years
Are there any attributes you would prefer in a mentee? (e.g., being matched to a mentor of the same gender – note that our ability to honour such requests depends on the availability of suitable mentors)
Submit