Mentor Faculty Application Instructions: Complete this application online. Please provide thoughtful responses that are as focused and specific to the program’s questions as possible. You may want to write your responses as an off-line text document, and then cut and paste them into this application form. Once you submit, you cannot return and correct sections, so please be careful in your responses. You will receive an automatic reply indicating that the application has been successfully submitted. Personal Information: Name: Address: City/State/Zip: | | Phone: Fax: Email: Statement of Interest: I am interested in being an ongoing member of Antioch’s Approved Mentor Faculty in the PhD in Leadership & Change Program so that my name, contact information, and resume will be placed in the program’s internal directory for student review and selection. -OR- I am interested in being an Approved Mentor Faculty in Antioch’s PhD in Leadership & Change Program for a particular student. Student's Name: Highest Degree Earned: In What? From Where? When? Current Employment: Employer: Position: Additional Questions: Identify learning areas in which you would be interesting in mentoring students and discuss your scholarly/professional qualifications to do so. This is what would appear in the Mentor Directory for student review if your application is approved for inclusion. If you are applying to be a Mentor for a particular student who has approached you already, please be specific about your areas of expertise to help this student in his/her learning. Discuss your interests and strengths in mentoring adults. Successful Mentors in this program must have the ability and interest in working with self-directed graduate students in an individualized learning plan that requires mentors who can both respect and challenge the student’s own intentionality in study, while adhering to high program standards. Share a story that tells us about your most meaningful learning experiences (whether as a student, teacher, mentor, or peer) and why it was so meaningful. Your response should help us understand how you would approach the mentoring role in this program and how you would aspire to work as a mentor with the individualized learning goals of our doctoral level students. Share your prior experience and/or thoughts about working with doctoral students studying in a practitioner-oriented doctoral program in leadership and organizational change in the professions. If you have taught or worked with doctoral students previously, please share information about where and when, and what you most enjoyed about that experience. If you have not worked with doctoral students previously, please share what you think the challenges would be for you, and what type of support you would need from the student and the program to be a successful Mentor. What appeals to you or concerns you about the Mentor Responsibilities in this Program? The explanatory material accompanying this application identifies the responsibilities and expectation of the Mentor Faculty in this distinctive and innovative program. Please share with us any thoughts about the role, responsibilities, or expectations that stand out for you, or that you would like to discuss further. If you are applying to Mentor a particular student, and have so identified this in the application, please share with us how you know the student, and any past or current relationship you have with the student. Please feel free to share anything else about you about your interests, background, and/or ideas that will help the Program get to know you a little better. Include your most current resume. Please cut and paste into this section your most current resume. We are interested in seeing the range of your scholarly and professional experience. Please paste information that will be readable as plaintext. Now that you have completed this application, click on the "Submit This Application" button below. You should hear back from the Program within two weeks. Thank you for your interest in the PhD in Leadership & Change.   If you have any questions or comments in the interim, please feel free to contact the Program Office (937-769-1360; office@phd.antioch.edu) or the Program Director, Dr. Laurien Alexandre (323-666-8181; lalexandre@phd.antioch.edu)

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