Student Mentorship Application
There are no fees or costs associated with the mentorship program. Students seeking to be mentored must be enrolled in/applied to a CPM program of study. However, potential mentees that need assistance choosing a program will not be denied help. Mentees will also apply using the Best Fit Questionnaire.
Name *
First and last name
Your answer
Email *
Your answer
Phone number *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
Race *
Your answer
Which best fits your current situation? (check all that apply) *
Required
If you are currently enrolled in a program of study, please list here: *
Your answer
How long have you been a student midwife? *
Your answer
What preceptors have you worked with? Please list them by name and location. *
Your answer
What experiences have you had as a student midwife? *
Your answer
What barriers need to be overcome in order for you to become a midwife? *
Your answer
What are your main interests in midwifery? *
What are you looking for in a mentorship? *
Your answer
Are you able to travel or do you need a mentor that is close to you? *
Your answer
What skills workshops would you be most interested in attending? *
Required
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