Enhancing Cultural Awareness (ECA) Module Request Form

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Thank you for your interest in receiving the facilitator guide and participant materials for the new Enhancing Cultural Awareness module, a new chapter in the Entering Mentoring Series. Please complete the fields below to receive your copy.

1. Last Name *

2. First Name *

3. What type of position do you hold at your institution? *

Professor

Scientist or Researcher

Academic Leader (e.g., Dean)

Instructor

Training Program Director

Academic Staff Member (e.g., Program Manager)

Postdoctoral Fellow

Graduate Student

Other:

Required

4. Are you an NRMN or CIMER Trained Facilitator in Entering Mentoring or Entering Research? *

Yes

Uncertain

5. When do you plan on implementing an ECA workshop? *

1-3 months

4-6 months

6-12 months

Uncertain

Required

6. Title *

8. Department *

9. Institution Name *

10. Email Address *

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