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 indicate your areas of interest/expertise in Psychosocial Oncology (check all that apply):

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* 6. Please select your top three topics that you would like to discuss with your mentor.

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* 7. Is there a specific area of interest that you would like to see your Mentor help you with for practice and/or better understanding?

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

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* 10. 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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* 11. 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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* 12. If you have other criteria that is exceptionally important to you that is not listed in question #9, please add and rate them here:

  1 (being the highest priority) 2 3 (being the lowest priority)
Additional Criteria 1:
Additional Criteria 2:
Additional Criteria 3: 

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

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* 15. What are your expectations in a mentor?

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

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* 17. Please provide a 2-3 sentence bio about yourself, 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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