One-on-One Mentorship Registration Form

Name(Required)

First Last

Mailing Address(Required)

We will send a welcome package, and gift to the address provided.

Email(Required)

Phone(Required)

T-Shirt Size(Required)

As a token of our appreciation, you will receive a t-shirt from the scholar team.

Attending School/University

Degree Type?(Required)

Research Proposal Topic?(Required)

Methodology Selection?(Required)

Do you have your program rubric?(Required)

(dissertation evaluation checklist or program guide)

Identify your current stage of the doctoral process?(Required)

Identify 1-2 specific areas (chapters/sections) that you would like us to help you complete by the end of the program?

Rate the level of priority of the 1-2 areas that you want to accomplish by the end of the program?

Any additional information you would like to provide?(Required)

How did you hear about Us?(Required)

Desired Mentor (1:1 COACHING PROGRAMS ONLY)

Qualitative – Dr. Tamika E. Haynes

Qualitative - Dr. Elizabeth Vargo

Qualitative/Mixed Methods - Dr. Li Ma (Mary)

Qualitative/Mixed Methods - Dr. Travis Hartin

Quantitative (Statistician) - Dr. Lihua Xu

(Your 1:1 dissertation coach is assigned based on your methodology selected above)