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Yale Department of Psychiatry
Junior Faculty Mentoring Program
Mentor Selection Form
Your name
Current Primary Mentor
Division Director or Institution Head
Primary area of work
Potential Track (Research, Clinician Educator, Traditional?)
Senior Assistant/Associate/Full Professors with similar interests
Other faculty members with whom you have discussed your work
Colleagues in other departments with related interests
Colleagues who teach/do clinical work/research with you
Faculty you would like to have on the committee
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