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NYSPHC Fellowship Program Mentor Interest Survey

Please complete the following survey to express interest in becoming a New York State Public Health Corps Fellowship Program (NYSPHC) Mentor. Mentors serve as professional role models and technical advisors to NYSPHC Fellows, facilitating their peer-learning and providing relevant mentoring, career planning and navigational support. The NYSPHC Fellowship Program will be utilizing a cohort style of mentoring with Mentors leading between 4-8 NYSPHC Fellows for up to two years with the expectation to meet on a quarterly basis.
1.Name: (Required.)
2.Title: (Required.)
3.Organization Affiliation: (Required.)
4.Work Location: (Required.)
5.Professional Background & Interests:(Required.)
6.Resume (optional)
No file chosen
7.Years of Experience in the public health field: (Required.)
8.Area of Expertise (select all that apply):(Required.)
9.How many Fellows would you like in your cohort (between 4-8)? (Required.)
10.Are you interested in co-leading a cohort?(Required.)
11.Availability/Commitment: Cohort Scheduling (Mentors are expected to meet quarterly with their cohort. However, cohorts can meet more frequently if desired. Mentors are encouraged to meet with their Fellows individually, as well) (Required.)
12.Availability/Commitment: Mentor Quarterly Check Ins (Mentors are expected to meet with NYSPHC staff and all other Mentors statewide twice a year for one hour) (Required.)
13.Availability/Commitment to attend NYSPHC events (Mentors are encouraged to attend other NYSPHC events such as Educational Series, Consortia, and the annual Summit) (Required.)
14.Do you have any recommendations for individuals who may be interested in being a NYSPHC Mentor? (Required.)
15.If yes, please provide the individual(s) names and email addresses. A NYSPHC Team member will contact them with additional information.