APOS Mentoring Program Survey - 2023

Get Paired with a Mentor or Mentee Today!

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* 1. Your Name:

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* 2. Your Email:

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* 3. Your Affiliation:

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* 4. Are you interested in becoming an APOS mentor, mentee or possibly both?

Mentor

Mentee

Both

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

Student

Postdoctoral

Early Career: 1-10 years (within 10 years of completing the terminal research degree or within 10 years of completing medical residency or equivalent)

Mid-Career: 10-25 years

25+ years

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* 6. Which specialty background do you identify with most?

Psychologist - PhD/PsyD

Psychiatrist - MD/DO

Physician/MD

Medicine, MD/DO, not Psychiatry (e.g., internal medicine, pediatrics, family medicine, neurologist)

Social Worker/Therapist MSW, LCSW, LMFT

Nurse Practitioner/RN/Clinical Nurse Specialist

Other (please specify)

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* 7. How would you rank the following considering your professional identity?

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* 8. What population do you primarily focus on?

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* 9. Please take a look at the following list and rank which topics you would like to discuss with your mentor/mentee.

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* 10. Is there anything else important to you that we have not addressed?

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* 11. If there are people you would like to be connected to please identify them here.

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* 12. If you have a CV, please upload it here.

PDF, DOC, DOCX file types only.

Choose File

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* 13. Your Age:
Note - this information is only to track the participants of the Mentoring Program and are NOT used in the matching Mentors and Mentees.

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* 14. Please select your Race:
Note - this information is only to track the participants of the Mentoring Program and are NOT used in the matching Mentors and Mentees.

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or other Pacific Islander

White/Caucasian

Other

Prefer not to disclose

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* 15. Which of the following best describes your ethnic background?:
Note - this information is only to track the participants of the Mentoring Program and are NOT used in the matching Mentors and Mentees.

Spanish/Hispanic/Latino

Not Spanish/Hispanic/Latino

Prefer not to disclose

APOS Mentoring Program Survey - 2023

Get Paired with a Mentor or Mentee Today!

Question Title

* 1. Your Name:

Question Title

* 2. Your Email:

Question Title

* 3. Your Affiliation:

Question Title

* 4. Are you interested in becoming an APOS mentor, mentee or possibly both?

Question Title

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

Question Title

* 6. Which specialty background do you identify with most?

Question Title

* 7. How would you rank the following considering your professional identity?

Question Title

* 8. What population do you primarily focus on?

Question Title

* 9. Please take a look at the following list and rank which topics you would like to discuss with your mentor/mentee.

Question Title

* 10. Is there anything else important to you that we have not addressed?

Question Title

* 11. If there are people you would like to be connected to please identify them here.

Question Title

* 12. If you have a CV, please upload it here.

Question Title

* 13. Your Age: Note - this information is only to track the participants of the Mentoring Program and are NOT used in the matching Mentors and Mentees.

Question Title

* 14. Please select your Race: Note - this information is only to track the participants of the Mentoring Program and are NOT used in the matching Mentors and Mentees.

Question Title

* 15. Which of the following best describes your ethnic background?: Note - this information is only to track the participants of the Mentoring Program and are NOT used in the matching Mentors and Mentees.

* 13. Your Age:
Note - this information is only to track the participants of the Mentoring Program and are NOT used in the matching Mentors and Mentees.

* 14. Please select your Race:
Note - this information is only to track the participants of the Mentoring Program and are NOT used in the matching Mentors and Mentees.

* 15. Which of the following best describes your ethnic background?:
Note - this information is only to track the participants of the Mentoring Program and are NOT used in the matching Mentors and Mentees.