USC Chan Division of Occupational Science and Occupational Therapy

Some people prefer mentors with shared identities, cultural backgrounds, and/or lived experiences. Answering the following demographic questions will help us to create the best possible match for each mentee request.

Please note that, aside from providing your name, and confirming that you are at least 18 years old, the questions in this section are all optional, and all information will remain confidential.

Your education

Your contact information

Your application

About your mentorship

The questions in this section are required.

Please briefly describe any populations you’ve worked closely with and areas of practice in which you have clinical or research experience (e.g., mental health, school-based practice). Current students can list fieldwork and volunteer experience.

How has your lived experience influenced you to apply to be a mentor? Are there any specific factors/experiences that you think position you to support a mentee?

Are there any specific characteristics you are seeking in a mentee and/or are there particular populations or identities that you are passionate about working with?

What do you hope to gain by participating in this mentorship program as a mentor?

Would you be interested in mentoring more than one mentee?	Yes No
Are you committed to contacting your mentee/s at least once per month to check in?	Yes No

About your menteeship

The questions in this section are required.

Are there any specific areas of practice and/or populations you are interested in working with as a future occupational therapist/researcher (e.g., mental health, children diagnosed with autism)?

Are there any factors, identities, or specific lived experience that might better position a mentor to support your needs?

What do you hope to gain by participating in this mentorship program as a mentee?

Who would you prefer to have as your mentor? (check all that apply)	Current USC Chan student USC Chan faculty / staff USC Chan alumni
Are you committed to communicating with your mentor at least once per month?	Yes No

First / given name *
Last / family name *
Are you at least 18 years old? * (You must be at least 18 to participate.)	Yes No
Gender
Pronouns (e.g., they/them/theirs)
Do you identify as LGBTQIA+?	Yes No
What is your ethnic / cultural identity?
What is your citizenship status?	US Citizen Permanent Resident Undocumented (DACA Status? ) International Other
What is your religion / creed (if any)?
What is your hometown?
Do you speak any languages other than English?	Yes: No
Are you a veteran / active military?	Yes No

Were / are you a first-generation student?	Yes No
Were / are you a non-traditional student? (A non-traditional student is someone who returns to school after a significant break or interruption, such as starting a family, switching careers, or serving in the military.)	Yes: No
Your undergraduate college / university
Your undergraduate degree and subject / major (e.g., BA English)
Your graduate college / university
Your graduate degree and subject (include your last graduate degree, if you have more than one)

Email address
Cellphone number
Preferred method of communication (check all that apply)	Email Phone Text

Are you applying to be a mentor or mentee? (check all that apply)	Mentor Mentee
Please note your USC Chan affiliation (check all that apply)	Current student Prospective student (mentees only) Faculty / staff (mentors only) Alumni (mentors only)
As a current student, your program and expected year of graduation
As a prospective Chan student, your USC Chan program of interest, current school, and expected year of graduation
As an alumni, program you graduated from, and year of graduation
Are you interested primarily in occupational therapy as a clinician, or occupational science as a researcher?	OT clinician OS researcher
How did you hear about this program?
Have you applied to be a mentor/mentee in the Chan division before?	Yes No

Access, Mentorship, Opportunity Program
Application

About you

Your education

Your contact information

Your application

About your mentorship

About your menteeship

Submit application

Access, Mentorship, Opportunity ProgramApplication

About you

Your education

Your contact information

Your application

About your mentorship

About your menteeship

Submit application

Access, Mentorship, Opportunity Program
Application