VOTA Children and Youth Practitioner Mentorship Connection
If you are an experienced pediatric practitioner, new graduate, or practitioner new to a pediatric practice setting interested in being matched for mentorship, please complete the following form. We would like to connect mentors and mentees based on interests, practice settings, and proximity. A meet-up will be arranged at the VOTA School System Symposium March 6-7, 2020. If you are not already a VOTA member, please join VOTA to participate in this opportunity.
Thank you for your interest in mentorship!
Name and Credentials
Contact Information (email and phone number)
Are you interested in being a mentor or mentee?
Workplace (please list name of organization or school system)
What is your primary practice setting?
In which region do you live and/or practice?
Blue Ridge (Zip codes beginning with 226-229, 244)
Capital (Zip codes beginning with 224-225, 230-232, 238-239
Northern (Zip codes beginning with 200-201, 220-223)
Southeastern (Zip codes beginning with 233-237)
Western (Zip codes beginning with 240-243, 245-246)
How many years of experience do you have in pediatric practice?
Less than 1 year
1 - 5 years
5 - 10 years
10 - 20 years
20 years +
What area(s) of practice would you like to focus on for mentorship?
School/community mental health
Contextual and collaborative service provision
General OT Process (evaluations, interventions, IEP development, etc.)
OTA roles, supervision, and collaboration
Multi-tiered Systems of Support
Do you plan to attend the VOTA School Symposium?
Any questions, comments, or additional information you wish to share:
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