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Doctoral Program in Educational Leadership Mentor Assignment Form

Welcome to the Mentor Assignment Form for the Doctoral Program in Educational Leadership. This form is designed to facilitate the assignment of appropriate mentors to doctoral candidates based on research interests, professional goals, and learning objectives. Please complete all required sections carefully to ensure optimal mentor-mentee matching.

Important Note: All mentor assignments are final for the academic year. Requests for changes may be submitted to the Doctoral Studies Committee with appropriate justification.

Student Information

Full Legal Name *

Student ID Number *

Email Address *

Program Start Date *

Current Academic Year *

Current Academic Standing *

Mentorship Preferences

Primary Research Focus Area *

Methodology Preference *

Potential Dissertation Topic (Brief Description) *

Professional Background *

Years of Professional Experience *

Mentor Selection

Mentor Preference *

Specific Faculty Mentor Preference (Optional)

Faculty Mentors Specialization Areas

Faculty Name	Specialization Areas
Dr. Rebecca Thompson	Educational Equity, Policy Implementation, School Reform
Dr. Michael Chen	Educational Technology, Assessment, Data-Driven Decision Making
Dr. Sarah Johnson	Curriculum Design, Instructional Leadership, Professional Development
Dr. James Williams	Higher Education Governance, Student Affairs, Institutional Research
Dr. Alicia Rodriguez	Bilingual Education, Multicultural Studies, Community Engagement
Dr. David Kim	Educational Finance, School Law, Organizational Theory

Specific Practitioner Mentor Preference (Optional)

Additional Mentor Information Needed (Optional)

Professional Goals

Intended Career Path After Doctoral Program *

Specific Skills or Knowledge Areas to Develop Through Mentorship *

Mentorship Commitment

Mentorship Expectations:

Monthly meetings with mentor (minimum of 1 hour)
Quarterly progress reports submitted to the Doctoral Program Office
Annual mentorship evaluation and renewal process
Willingness to engage in reflective dialogue about leadership practice
Commitment to mutual growth and learning

By submitting this form, I acknowledge that I understand the mentorship expectations and commit to fulfilling my responsibilities as a mentee. *

Additional Information

Accommodations for Mentorship Activities (Optional)

Questions or Concerns Regarding Mentorship (Optional)

Mentorship Timeline

Milestone	Description	Timeline
Form Submission	Submit completed Mentor Assignment Form	Before September 1st
Mentor Assignment	Receive mentor assignment notification	By September 15th
Initial Meeting	First meeting with assigned mentor	By October 1st
Mentorship Agreement	Complete mentorship agreement form	By October 15th
Progress Report	Submit first quarterly progress report	December 15th

Contact Information:

For questions about the Mentor Assignment process, please contact the Educational Leadership Doctoral Program Office:

Email: doctoral.edleadership@university.edu
Phone: (555) 123-4567
Office: Education Building, Room 301

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