Become a Faculty Mentor and/or Portfolio Reviewer

If you are a community-engaged faculty member, apply now to be listed in the Community-Campus Partnerships for Health Online Database of Faculty Mentors and Portfolio Reviewers.

 

The database is used by community-engaged faculty who are searching for faculty mentors and by deans, department chairs and others who are searching for external experts to review portfolios of community-engaged faculty who are being considered for promotion and/or tenure.

 

To begin the application process, please complete the form below. Once we have received your completed application form, we will be in touch with you by email within 2 weeks with a decision on your application. If you are listed, the information you provide in your application will be available and searchable online to registered users. If you have any questions, please contact us at facultydatabase@ces4health.info.

 

To download a copy of the application to help you in preparing your narrative answers for the online form, click here.

 

(*) denotes required field

1. * Do you hold an academic appointment at a higher educational institution?

CONTACT INFORMATION

* First Name:

 

* Last Name:

 

Department or Unit (if applicable):

* Institution/Organization:

 

Mailing Address Line 2:

* City:

 

* Country:

 

Middle Initial:

* Job Title:

 

College or School (if applicable):

* Mailing Address Line 1:

 

Mailing Address Line 3:

* State or Province:

 

* Zip or Postal Code:

 


* Email (This will be the primary way
we communicate with you):

* If accepted, what would you like your
password to be for your login?

 

* Phone (with area code):

Skype Address:

 



* Confirm your Email Address:

 


* Confirm Password:

 

Fax (with area code):

Website:

 


 

DEMOGRAPHIC INFORMATION

Please indicate your gender.



How would you identify your race/ethnicity? (Check all that apply)















APPLICATION QUESTIONS

1. * What is your faculty rank?  





if other, please specify: 


2. * What is your tenure status at this institution?





3. * Please indicate the nature of your higher education institution. (Check all that apply)









if other, please specify: 


4. * Please indicate your discipline/profession (Check all that apply).
















if other, please specify:


5. Please indicate your sub-specialty fields(s) if applicable (e.g. family medicine, pediatrics).


6. Please indicate your degree(s), if applicable. (Check all that apply)
















if other, please specify: 



7. * Please indicate if you have experience and/or expertise in the following topics (Check all that apply).  












































if other, please specify: 

8. * Please indicate if you have experience and/or expertise in the following methodological approaches (Check all that Apply).













if other, please specify: 


9. * Please indicate if you have experience and/or expertise working with any of the specific populations listed below (Check all that apply. If this question is not applicable, please check "other" and type "NA" in the entry field.).













if other, please specify: 


10. Please indicate reviewer roles you have played in the past (Check all that apply.):









11. Please indicate mentor roles you have played in the past: (Check all that apply.)





12. Please indicate if you have served as a Principal Investigator, Co-Principal Investigator or Investigator on grants from any of the following funding agencies.











13. * Please provide a 1-2 paragraph biographical sketch, emphasizing areas of relevant expertise and accomplishment (2000 character limit)

 


14. * Provide a brief statement indicating why you want to become a faculty peer reviewer and/or mentor. Describe your involvement in community-engaged scholarship and your commitment to supporting community-engaged faculty as they move ahead in their careers (4000 character limit)

 

15. * If you could give one piece of advice to a graduate student or post-doctoral fellow planning a community-engaged career in the academy, what would it be? (2000 character limit)

 

16. * If you could offer one tip to a community-engaged faculty member preparing a portfolio for promotion and/or tenure, what would it be? (2000 character limit)

 

17. * Please indicate the approximate number of faculty promotion/tenure portfolios you could review annually.: (You are not obligated to agree to all the requests you receive. You may accept or decline as you wish, for any reason):  


18. * Please indicate the approximate number of mentor inquiries you could fulfill annually. (You are not obligated to fulfill all inquiries. You may accept or decline as you wish, for any reason):

19. * Please attach as a PDF file the most current copy of your curriculum vita or resume.  



or provide a URL to your curriculum vita:
 


* I have read and agree to the privacy policy  



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