INSAR C-CAP Mentee Application

This application allows you to sign up to receive mentorship, in the areas you are interested in. After applying, the goal is to place you with one ore more mentors to work with, which can range from a one-time connection to potentially longer-term mentoring.

*1.Name(Required.)

*2.Your Email Address(Required.)

*3.Phone Number(Required.)

*4.Highest Earned Educational Degree(Required.)

5.For Students: Anticipated Date of Graduation

6.For Students: Current Graduate/Undergraduate Program

*7.Which of the following best describes you?(Required.)

Undergraduate student (Bachelor’s or equivalent)

Graduate Student (Masters, DClin, EdD., Ph.D., PsyD, other)

Postdoctoral fellow/Resident

Professional clinician/practitioner in autism

Faculty, Professor, Trainer

Researcher

Autistic Self-Advocate

Family/friend of an autistic individual

Other (please specify)

8.Current Work Setting (i.e., hospital, clinic, university)

9.Years of Experience in this Position

10.Current Country of Residence

11.What nationality/nationalities do you identify as?

12.Please select the topic(s) in which you are interested in receiving mentorship:

Building international collaborations

Career planning

Clinical skills

Communication/writing skills

Data analysis/statistical analysis

Grant writing

Leadership development (e.g. leading a team, leading as a PI)

Project administration (developing budgets, IRB/ethical approvals, etc.)

Research methodology (qualitative, quantitative, eye-tracking, EEG, fMRI, other)

Research study design

Integrating research into clinical/community practice (e.g., community participatory research)

Other (please specify)

13.Please share your current topic(s)/area(s) of work/interest. For example intervention research, finding biomarkers, international and cross-cultural perspectives.

14.Please write a short biography and career goals and how participation in C-CAP will help achieve stated career goals (no more than 250 words).

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