Application for Mentors for 2019 program
Apply to become a Mentor of either a resident, fellow, junior attending, junior NP, RN, or pharmacist organized through the Neurocritical Care Society, Trainee Committee. Applications are due Wednesday, December 12th 2018.
Please make sure to also email a copy of your CV to ncs.rftf@gmail.com with the subject line "Mentor Application" to be considered.
Email address *
What is your name?
Your answer
What institution are you associated with?
Your answer
What is your email?
Your answer
Years of practice as a neurointensivist?
What is your primary specialty?
Do you prefer a mentee from your speciality?
Level of trainee you are most interested in mentoring?
In which scope(s) of practice do you prefer to mentor: (rank up to 3 preferences)
1
2
3
Clinical
Research
Education
Administration
Ethics
Publishing
Guidelines
Outreach
In a few sentences, please elaborate in your choices above, including any specific interests that you have within neurocritical care
Your answer
The mentorship program is designed to be project oriented. Describe/Name 2 potential projects you feel would be feasible and beneficial to both yourself and your mentee to complete over the course of 1 year. (e.g. write a review paper/ case report/ book chapter, original research, design a residents neurocritical care curriculum, write a grant...)
Your answer
Which of the following meetings, if any, do you plan to attend this year? (choose all that apply)
In a few sentences, what do you consider as key to making this a productive mentorship experience?
Your answer
Would you be able to commit 2-4 hours a month to mentor in this program?
A copy of your responses will be emailed to the address you provided.
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