[ Close Window ]  

Please fill out this questionnaire as thoroughly as possibly. The Hispanic Center of Excellence Mentoring Board will review your request and work to place you with the appropriate mentor(s). Starred (*) items are required. If you have any questions, please contact Norma Perez, M.D., Dr.P.H. at noaperez@utmb.edu or at 409.772.3558.

*Required

  • *Name:
  • *Department:
  • *Email:
  • *Department Chair:
  •  
  •  
  • *Position:


  •   
  •  
  • *Would you like to have one or more mentors through the HCOE?


  •   
  •  
  • *Do you have a current mentor?


  •  
  • If so,


  •  
  • What type of mentor are you looking for? You may check more than one. Please rank by the priority (e.g. 1 = the highest priority)
  •     1 2 3 4 5
    Clinical  
    Basic science  
    Translational/Clinical research  
    Education  
    Academic
    (clinical/research/educator)
     
    Career mentor  
  •  
  • Specific areas of mentoring need (rank all that apply by number)
  •     1 2 3 4 5
    Promotion and tenure  
    Scientific exchange  
    Grant preparation  
    Review activities (grants/ journal articles)  
    Minority faculty issues  
  •  
  • If another type of mentoring is needed, please explain.
  •  
  • Additional Information/Comments/Requests
  •  
  • UTMB Safe Submit
    What is five plus one?

     
  •  
  •