PBI Mentor Application
Thank you for your interest in being a part of our mentorship pool for the Pro Bono Incubator (PBI). We request that you fill out this short survey for us to gain some background knowledge about your areas of current/previous experience. Our goal is to utilize this information to best pair mentors and mentees to create successful partnerships.
Once your application is received, we will reach out to you within 1 week with further information. Our goal is to create a core group of mentors to best meet the needs of our mentees.
Current Affiliated Organization(s)
Please share current pro bono programs affiliated with and/or current work affiliations.
What is your current role affiliation?
Pro Bono Program or Clinic Leader
Speech Language Pathologist/SLPA
Other Healthcare Professional
Student ~ PT/PTA
Student ~ OT/OTA
Student ~ SLP/SLPA
Other Healthcare Student
Current/previous practice areas (Select all that apply)
Skilled Nursing Facility
Years of experience in pro bono/nonprofit setting.
Types of pro bono experience (select all that apply)
Starting a new clinic
Do you have experience with...? (Select all that apply)
Northeast (ME, VT, NH, MA, RI, CT, PA, NY, NJ)
Southeast (MD, DE, DC, VA, WV, NC, SC, GA, FL, AL, MS, LA, AR, TN, KY)
Midwest (OH, MI, IN, WI, IL, MO, IA, MN, ND, SD, NE, KS)
West (MT, WY, CO, ID, UT, WA, OR, CA, NV, AK, HI )
Southwest (AZ, NM, TX, OK)
Is there anything you would like to share that you feel is relevant and was not covered by the rest of the application?
Send me a copy of my responses.
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