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
with the subject line "Mentor Application" to be considered.
What is your name?
What institution are you associated with?
What is your email?
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?
Junior Faculty (0-5 years of practice)
Nurse Practitioner in the first 3 years of practice
In which scope(s) of practice do you prefer to mentor: (rank up to 3 preferences)
In a few sentences, please elaborate in your choices above, including any specific interests that you have within neurocritical care
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...)
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?
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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