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School of Public Health:
Mentoring Program
Nominate to be a Mentee or Mentor

Note: This information will remain confidential, for mentoring matching purposes only

Title*

First Name*

Last Name*

Email*

Would you like to be a

Mentee

Mentor

Both Mentee and Mentor

Current supervisor*

Research Group/Division*

Research area of interest*

Date PhD conferred

What are your goals for mentoring?*

Please nominate some names of preferred mentors
	Not compulsory