Curry School Standing Committee on Doctoral Studies Ph.D. Mentor Application Form 2015-2016 Dear Curry Faculty, Thank you for your interest in being a Ph.D. mentor. Please complete this application form and e-mail it to Patrick Meyer ([email protected]) by February 16, 2015. You only need to list activity over the last 5 years (2009-2014). Please cut and paste from your CV and or annual reports. Where appropriate please bold the names of PhD students (e.g. Research publications/presentations). Refer to the Faculty Council Criteria for Faculty to serve as Mentors in the Research-Focused PhD for additional information. Name: ____________________________________ Department: ______________________ Mentor Category Request: Mentor Research Mentor Academic Advisor I. PhD Mentors engage in scholarship (see Criteria 1 from the Faculty Council Criteria for Faculty to serve as Mentors in the Research-Focused PhD) Research and scholarly publications: Research and scholarly presentations: Grants (If Applicable): Other Scholarly Activity: II. Activities Related to Academic Mentoring, Research Mentoring, Student Support, Coaching, and Career Development (see Criteria 2 from the Faculty Council Criteria for Faculty to serve as Mentors in the Research-Focused PhD): III. List Ph.D. students who have graduated within the past 5 years with whom you have worked and your role (mentor, co-mentor, academic advisor or research advisor) and where they were placed or are working now: IV. Please describe (optional) your strengths and capacity as a mentor for PhD students that you feel were not described sufficiently above and how your mentoring will help strengthen PhD training at Curry.