Become a Mentor!

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* 1. Your Name: 

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* 2. Your Email:

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* 3. What is your discipline?

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

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

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* 5. Please indicate your primary areas of expertise in Psychosocial Oncology: (please select all that apply)

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* 6. Please review the following list and indicate how interested you would be in discussing these topics with your mentee. We will use this list to guide our match based on areas mentees express interest in discussing with their mentors(please select all that apply)

  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

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* 7. We would like this mentorship program to help you in forwarding your own projects and initiatives. Please take a look at the following list and identify which projects and/or initiatives you are interested in having a mentee support.
Please rate the topics of importance to you so that we can consider them in the match. 

  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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* 9. How many mentees would you be interested in having?

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* 10. How frequently would you like to correspond with your mentee(s):

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* 11. What is your preferred method of correspondence with your mentee(s): (in addition to an in person contact during the annual meeting)?

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* 12. Please rate the criteria, based on personal importance, by which you would like to be matched with your mentee(s):

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

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

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

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* 15. Please  email your bio to stomlinson@parthenonmgmt.com.  Please also comment below about your daily work environment, including research interest, and anything else you think might be useful in matching you with a mentee. (optional)

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