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INSAR C-CAP Mentor Application
This application allows you to sign up to become a mentor – mentors of all career levels are sought! Mentoring can be short term, or long term, depending on the situation, needs and time that can be devoted.
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1.
Name
(Required.)
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2.
Your Email Address
(Required.)
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3.
Phone Number
(Required.)
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4.
Highest Earned Educational Degree
(Required.)
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5.
Which of the following best describes you?
(Required.)
Graduate Student (Masters, DClin, EdD., Ph.D., PsyD, other)
Postdoctoral fellow/Resident
Professional clinician/practitioner in autism
Faculty, Professor
Researcher
Autistic Self-Advocate
Family/friend of an autistic individual
Other (please specify)
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6.
Current Work Setting (i.e., hospital, clinic, university)
(Required.)
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7.
Years of Experience in this Position
(Required.)
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8.
Current Country of Residence
(Required.)
9.
What nationality/nationalities do you identify as?
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10.
Please select the topic(s) in which you are comfortable providing mentorship:
(Required.)
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)
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11.
Please select the topic(s) in which you currently work/have expertise in:
(Required.)
Animal Models
Biomedical research (genetics, biomarkers)
Phenotyping/clinical characterization (including diagnostic, behavioral, communication/language, intellectual assessment and studies of co-occurring conditions)
Education and training of current and future professionals
Epidemiology/population studies
International and Cross-Cultural Perspectives
Interventions - Non-pharmacologic
Medication interventions
Neurology/Neurophysiology/Electrophysiology
/Neuroscience/Neuroimaging
Other (please specify)
12.
Is there anything that you would like the committee to know to aid your mentor/mentee match (e.g., knowledge of languages, experiences in geographic regions, experiences with specific populations/cultures)?
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13.
Please provide a link to your biography, or a short statement on your professional experience.
(Required.)
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14.
Please provide a brief statement regarding your prior experience with mentoring.
(Required.)
