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 (jpm4qs@virginia.edu) 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.