Mentorship Program Application for Early Career Psychologist Mentors
Are you a first-time applicant?
University attended for your doctoral program:
Degree and date your degree was awarded (e.g., Ph.D. in Clinical Psychology, 2012):
If you completed or are completing post-doctoral training, please write the description of the position and dates of employment (e.g., Post-Doctoral Fellow at NYU Child Study Center, 2012-2013)
Name/description of your current job (e.g., Assistant Professor at University of Florida)
Please select one or more of the following options that describe your current describe current position:
Academic position in a university setting
Research position in an institution (e.g., VA Hospital)
Clinical position in an institution (e.g., community clinic, hospital)
Please check off one or more boxes below to indicate areas of research/clinical expertise:
Dissemination and Implementation
What are your goals and what do you hope to gain/provide from participating in this program?
Are you willing to communicate with your mentee at least once/month?
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