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CBE Mentor Application
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Name
Email
Alternate Email
Phone
Alternate Phone
Current Employer
Employment History (List post-BS employers and job titles)
Explain why you wish to participate in the Mentorship Program
Elective Focus Area(s) Qualified to Mentor (check all that apply)
Biochemical Engineering
Business
Chemical Process Engineering
Energy and Environment
Pharmaceuticals
Polymers
Pre-Medicine
Sustainability
Other (Explain below)
Elective Focus Area Other Details
Indicate Chemical Engineering activities of interest (check all that apply)
Mentor
Guest lecturer in courses
Speaker in Professional Seminar
Professional Advisory Board Membership
Other (Explain below)
Chemical Engineering Other Activities of Interest Details
Communication Preference (check all that apply)
E-mail
Phone
Text Message
In Person
Approval
I give my permission to forward my email address to Tom Marriott, an alumnus of the Chemical Engineering Program at the University of Iowa, who will be in charge of the mentoring program.
Leave this field blank