Join Or Update Survey | Mentorship Program

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Our goal is to create cross-departmental mentoring pairs that support the growth and development of the KU School of Medicine faculty.

We believe that mentoring increases faculty success and achievement. Our goal is that every faculty member can identify at least one senior KU School of Medicine faculty mentor outside of their department that serves on their team of mentors. Research suggests that having a team of mentors leads to a more successful and satisfying career. To learn more, please visit the Mentorship Program Website.

We kindly invite you to complete the form below to participate or update your mentorship program status.

School of Medicine Faculty Affairs and Development / Created: 03.03.2023 / Revised: 02.05.2026

Survey Year

2021

2022

2023

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Name:

* must provide value

Please Select your Degrees.

* must provide value

PhD

EdD

Other (free text option)

List Degree(s)

Email Address:

* must provide value

Are you signing up for the first time to be part of the mentorship program?

Yes

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Which of the following describes your intent for further participation in the mentorship program?

* must provide value

I would like to continue in the program and will continue working with my current assigned mentor and/or mentee (I am not seeking any new matches at this time).

I would like to continue in the program and want to be matched with a new mentor and/or mentee.

I will not be continuing in the program at this time.

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I wish to be a:

Mentor

Mentee

What are your top 2 goals for mentorship over the next 12 months?

What are the top 2 ways you hope to support or impact your mentee(s) over the next 12 months?

How many mentees do you currently have capacity for?

* must provide value

Which of the following best describes your next step?

What is your race and/or ethnicity?

For a list of existing affinity groups, please click here.

African

African American

Black

American Indian or Alaska Native

Asian

Asian American

South Asian

Native Hawaiian or Pacific Islander

Hispanic

Multiracial

White

European

Latinx

Middle Eastern or North African

My race/ethnicity is not listed (free text option)

What is your race and/or ethnicity?

Gender:

* must provide value

Woman

Man

Trans Woman

Trans Man

Gender Fluid

My identity is not listed: (free text option)

Prefer not to answer

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What are your pronouns?

She/her/hers

He/him/his

They/them

Mine are not listed (free text option)

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What is/are your gender(s) and/or pronoun(s):

Are you interested in participating in a mentoring group that is exclusively for women or URiM faculty (in addition to other mentorships that might arise from the mentor matching process)?

Yes

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Select all that apply.

Women

URiM

Both

How important is it to you to be paired with a mentor or mentee that identifies as a faculty underrepresented in medicine by race, ethnicity and gender?

Not Important

Somewhat Important

Very Important

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Please comment on your answer:

What is your primary campus?

What is your current faculty rank?

What is your academic track?

What is your department?

Please include your division name (if applicable).

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