ACvA Mentor Questionnaire Question Title * 1. Name Name Institution Job title Email Address Question Title * 2. Career level Group leader or laboratory head Clinical fellow Allied health professional Postdoctoral researcher Research assistant/technician Honours or Higher Degree Researcher student Other (please specify) Question Title * 3. Gender Male Female Prefer not to say Question Title * 4. Date PhD/Masters was awarded or expected completion date (year)? Question Title * 5. Are you a (check all that apply): Discovery scientist (basic, preclinical) Translational scientist Public health professional Allied health professional Clinician Clinician scientist Other (please specify) Question Title * 6. Are you affiliated with any of the following? Industry TGA Question Title * 7. What are you main areas of expertise? Question Title * 8. Does your main area of expertise involve patient engagement? Yes No Question Title * 9. What skills/experience could you offer to a mentee? Question Title * 10. What are your desired goals of being paired with a mentee? Question Title * 11. How frequently would you be available to meet with your mentee? Question Title * 12. If you have any other comments for us, please write them here Done
