Be an APOS Mentee!

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* 1. Your Name: 

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* 2. Your Email:

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* 3. What category best describes your current career stage?

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* 4. What is your discipline?

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* 5. Please tell us about your career interests.  How important are each of the following in terms of your career priorities?

  1  (highest priority) 2 3 (lowest priority)
Research
Clinical work
Teaching/Supervision

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* 6. Please indicate your areas of expertise in psychosocial oncology (please check all that apply).

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* 7. Please review the following list and indicate how interested you would be in discussing these topics with your mentor. We will use this list to guide our match.

  1  (very interested) 2 3 4 (a little interested) 5 6 7 (not interested)
Diversity experiences
Orientation to APOS/enhancing involvement in APOS
Provision of patient care (medical, mental health, spiritual)
Academic activities (i.e., drafting a submission, presentation development, manuscript development)
Fellowship / Job applications
Career advancement
Negotiating salary (i.e., first job out of training)
Professional identity development
Networking
Conducting Research
Teaching
Leadership skills
Program development
Work-family balance
N/A

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* 8. Please indicate which of the following areas of Psychosocial oncology that you are interested in learning more about (please check all that apply).

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* 9. Please indicate your #1 interest from above (question 7).

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* 10. We would like this mentorship program to help you fulfill a concrete goal/objective. Please take a look at the following list and identify which projects and/or initiatives you would like a mentor to help you complete. Please note, this may be your own personal project or that which belongs to a mentor.

  1 (very interested) 2 3 4 (a little interested) 5 6 7 (not interested)
Data analyses
Manuscript writing
Systematic Review
Assistance with grant proposals
Program development
Supervision
Clinical skills building & leadership
Teaching & mentoring
N/A

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* 12. How frequently would you like to correspond with your mentor?

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* 13. What is your preferred method of correspondence with your mentor (in addition to an in person contact during the annual meeting)?

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* 14. Please rate the criteria, based on personal importance, by which you would like to be matched with your mentor?

  1 (being the highest priority) 2 3 4 (being the lowest priority)
Professional discipline
Career interests (e.g., clinical work, spirituality, etc.)
Research interests
Preferred method of correspondence

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* 15. If you have other criteria that is exceptionally important to you that we have not addressed, please indicate so here.

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* 16. What types of webinars and/or print materials would be helpful to support your professional development (e.g., multicultural competency, telepsychology, evidence-based treatments)?

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* 17. Is there anything additional you would like to share about a potential mentoring experience?

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* 18. What are your expectations in a mentor?

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* 19. Please identify 2-3 ideal potential mentors through your APOS connections.

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* 20. Please email your bio to stomlinson@parthenonmgmt.com.  Additionally, please state below your daily work environment, including research interest, and anything else you think might be useful in matching you with a mentor. (optional)

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* 21. Are you also interested in being a mentor to trainees or other students or leaning how to become one? Please indicate yes even if you are interested in learning more about being a mentor. We may create a cohort of mentees who mentor trainees if we have enough interest.

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