ACerS Mentoring Program Application
Please fill out the form as completely as possible.
Our staff will review your submission and contact you as soon as possible.
Thank you for your interest.
Personal Information
First Name:
Last Name:
Job Title:
Employer:
Employer Address:
Business Phone:
Business Fax:
Gender:
Male:
Female:
Email:
Education and Interests
Colleges/Universities attended:
Degree(s) Earned:
Outside Interests:
Society Involvement and Qualifications
How long have you been a member of ACerS?:
Are you a member of an ACerS Division? (Check all that apply)
Art:
Basic Science:
Cements:
Electronics:
Engineering Ceramics:
Glass and Optical Materials:
Nuclear and Environmental Technology:
Refractory Ceramics:
Structural Clay Products:
Whitewares and Materials:
I do not belong to an ACerS division:
From the following options, which ones best describe your area of expertise?
Electronics:
Glass:
Refractories:
Nuclear:
Energy (other):
Environmental
Communications Tech:
Coatings:
Bio-medical:
Optics and Photonics:
Military:
Aeronautics:
Refractories:
Structural Ceramics – non oxide:
Structural Ceramics - oxide:
Building Materials:
Whitewares:
From the following options, which ones best describe your area of expertise?
Academic Institution
Government Agency or Laboratory
Corporate: Research
Corporate: Manufacturing
Corporate: Other
Biography and Statement of Interest
Please provide a brief biography (100 words or less):
Why do you want to be a mentor:
Is there any particular type of mentee with whom you would like to be matched including geography, school, area of interest, etc?:
Submit Application
We will contact you soon.