Building Relationships One Step at a Time. 

Interested in gaining an experienced perspective on applying textbook concepts to real-life situations? Looking to give something back to the profession? Sign up for the Academy Mentoring program and be an intricate part of the future of O&P.

Please submit your application for consideration below. Fields with a * are required.

All applications are due Thursday, March 1, 2018.

Last Name

Question Title

* 1. Last Name

Full Credentials (please enter n/a if not applicable)

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* 2. Full Credentials (please enter n/a if not applicable)

Email Address: (please provide an e-mail address that you check regularly and will not change within the next 12 months)

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* 3. Email Address: (please provide an e-mail address that you check regularly and will not change within the next 12 months)

Phone (please provide your preferred contact phone number with area code)

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* 4. Phone (please provide your preferred contact phone number with area code)

Have you participated in the Academy Mentoring Program in the past?

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* 5. Have you participated in the Academy Mentoring Program in the past?

I want to participate in this years Academy Mentoring Program as a:

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* 6. I want to participate in this years Academy Mentoring Program as a:

If in school, when will you or did you graduate? (An approximate day and month are acceptable, please provide an accurate year)

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* 7. If in school, when will you or did you graduate? (An approximate day and month are acceptable, please provide an accurate year)

Date / Time
Which O & P program are you attending or did you attend?

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* 8. Which O & P program are you attending or did you attend?

What is your area of interest (check all that apply)?

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* 9. What is your area of interest (check all that apply)?

Statement of Interest: Include a brief description of your long-term professional goals. What are the areas where you feel you need development (elaborate on the areas of interest you checked in the question above and/or provide a request for pairing preference)?

This information will be used to pair you in the mentoring program.

Question Title

* 10. Statement of Interest: Include a brief description of your long-term professional goals. What are the areas where you feel you need development (elaborate on the areas of interest you checked in the question above and/or provide a request for pairing preference)?

This information will be used to pair you in the mentoring program.

List any hobbies or interests.

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* 11. List any hobbies or interests.

By submitting this application, I agree that (if accepted into the program) I will take initiative, act in a professional manner, and be respectful of time commitments.

If you have any questions or concerns, please contact amp@oandp.org.

Thank you.

Question Title

* 12. By submitting this application, I agree that (if accepted into the program) I will take initiative, act in a professional manner, and be respectful of time commitments.

If you have any questions or concerns, please contact amp@oandp.org.

Thank you.

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