Mentorship Network Questionnaire

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1. Disclaimer of Warranties and Liabilities:

Completing this survey will serve as your consent to be contacted by individuals interested in mentorship. The inquiries through the Mentorship Network are self-reported and are not supervised by the AACAP. AACAP makes no warranties whatsoever, regarding the inquiries you may receive through the Mentorship Network service. In no case shall AACAP be liable to you or anyone else who uses the Mentorship Network. By using the Mentorship Network, you agree to do so exclusively at your own risk.

(Note: Please answer all survey questions. The submission of an incomplete survey will not ensure a mentor match.)

Disclaimer of Warranties and Liabilities: Completing this survey will serve as your consent to be contacted by individuals interested in mentorship. The inquiries through the Mentorship Network are self-reported and are not supervised by the AACAP. AACAP makes no warranties whatsoever, regarding the inquiries you may receive through the Mentorship Network service. In no case shall AACAP be liable to you or anyone else who uses the Mentorship Network. By using the Mentorship Network, you agree to do so exclusively at your own risk. (Note: Please answer all survey questions. The submission of an incomplete survey will not ensure a mentor match.) I agree to these terms and conditions.

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2. Please enter your full name.

Please enter your full name.

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3. Please indicate your gender.

Please indicate your gender. Male

Female

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4. Please enter a valid email address and phone number.

Please enter a valid email address and phone number. Email Address
Phone Number

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5. What is your ethnic background/origin?

What is your ethnic background/origin? European American

African American

Hispanic/Latino

Asian

American Indian/Pacific Islander/Alaskan American

Other (please specify)

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6. What is your current level of training?

What is your current level of training? Medical Student

General Psychiatry Resident

Child Psychiatry Resident

Triple-board Program Resident

Early Career Psychiatrist

Other (please specify)

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7. Where are you currently located?

Where are you currently located? City
State

Mentorship Network Questionnaire - MenteesExit this survey

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*2. Please enter your full name.

*3. Please indicate your gender.

*4. Please enter a valid email address and phone number.

*5. What is your ethnic background/origin?

*6. What is your current level of training?