FHS Mentorship - Mentee Engagement Survey Question Title * 1. Are you interested in participating in this program in the role of a Mentor (A mentor is someone who shares their knowledge, skills and/or experience, to help another to develop and grow. e.g. mentor through a research project - implies a longitudinal relationship)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901806/ (Required.) Yes No Question Title * 2. Are you interested in participating in this program in the role of a Mentee ? (Required.) Yes No Question Title * 3. Are you interested in participating in this program in the role of a Coach ? (A coach is someone who provides guidance to a client on their goals and helps them reach their full potential - intermittent suggestions on -what to do-- for e.g. negotiation , career related, clinical question - could be one time need - or multiple)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901806/ (Required.) Yes No Question Title * 4. Choose your current position and specialty (Required.) Fetal Cardiologist General Pediatric Cardiologist Fellow in training -Core Fellow in Training- Advanced Sonographer Nurse/NP/APN MFM OB Radiologist None of the above Question Title * 5. Which specific area are you interested in for Mentoring-Coaching (Required.) Career Development - Early Career Development - Mid - Leadership roles Life-Career Integration Research- Funded pathway Education and Scholarship - creating a portfolio Clinical Research Clinical Excellence Combination Other (please specify) Question Title * 6. What will your expected time commitment to this role be ( rough Estimate) (Required.) 1-2 hours a quarter 2-4 hours a quarter As needed Other (please specify) Question Title * 7. What is your desired goal/ outcome from participating in this program (Required.) Achieve a finish product - research design - initial phase Achieve continued engagement until a research product is completed Advise regarding your job - Negotiating, building CV , defining personal goals Career Development - e.g promotion , salary negotiation As needed Coaching/Clinical Opinion - One or two session only for - Clinical case opinion, Program Building, Research Question Other (please specify) Question Title * 8. Please Enter your Name and Particulars (Required.) Name Company Address City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number Question Title * 9. Please Upload a brief Bio reflecting your area of interest and expertise for the role you have selected above Done