ASHT Companion Clinic
Participant Questionnaire

The world is getting smaller. New technology has made it faster to connect with people around the globe, reaching even the most remote corners, an unthinkable probability a decade ago. Cheap and easy Internet-based communication has replaced expensive, hardwired phone lines allowing people to connect via chat messaging and even video at little to no cost, both with archived messages or in real time. Because of this, taking part in ASHT's Companion Clinic Program is now easier than ever.

In addition, the ASHT International Committee is excited to announce your participation in the Companion Clinic Program can now earn you CEUs to be used toward certified hand therapist recertification under the Hand Therapy Certification Commission's Category E, similar to ASHT's Mentorship Program.

The ASHT Companion Clinic Program pairs a U.S. clinic or hand therapist with an individual in a developing country, providing a unique opportunity to create relationships between therapists practicing under a diverse set of circumstances. Through regular communication, members pursue collaboration, clinical education and professional growth while promoting best practice in the field of hand therapy around the world. The Companion Clinic Program also offers members networking opportunities, the development of new skills and the satisfaction of actively assisting in the standardization of hand therapy practice on a global scale.

Following the completion of the below participant interest form, the ASHT International Committee will pair interested U.S. members or clinics with their international counterparts based on need, expertise and language.

Eligibility
Interested parties from a developing or underserved country do not need to be a member of ASHT to participate, but access to the internet for video or chat messaging is strongly suggested as the most timely and economic means of communication. However, the particular method of communication will be decided by each partnership. Prospective U.S. participants must be a current Active or Associate member of ASHT or have at least one member employed by the perspective clinic. Not all therapists in the clinic need to be ASHT members to participate in the sharing of information, and an individual member working alone in a clinic is also eligible. ASHT members who are currently in an academic setting or who are retired from practice are eligible as well and encouraged to participate.

Thank you for your interest in ASHT's Companion Clinic Program. You will be receive an email response from the International Committee shortly with more information.

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* 1. Name

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* 2. Credentials

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* 3. Title

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* 4. Email

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* 5. What is your current city and country of practice?

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* 6. What time zone do you currently live/work in?

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* 7. What best describes your current practice setting?

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* 8. Number of years in hand therapy practice

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* 9. Languages spoken

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* 10. Languages written

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* 11. Have you participated in a medical humanitarian trip?

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* 12. Date/location/setting or type of facility you visited

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* 13. Do you have regular access to the Internet?

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* 14. Do you have access to text messaging?

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* 15. Do you have access to video chat?

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* 16. What would be your preferred means of communicating with you Companion Clinic partner(s)?

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* 17. How often do you anticipate communicating with your Companion Clinic partner(s)?

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* 18. What days of the week/time of day do you anticipate communication with your Companion Clinic partner(s)?

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* 19. What do you hope to gain from participating in the ASHT Companion Clinic Program?

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* 20. Do you anticipate using hours earned in the ASHT Companion Clinic Program toward HTCC recertification?

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* 21. Do you already have an international clinic or partner in mind?  If so, please provide a contact name and email address.

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* 22. Is there anything else you would like to share with the ASHT International Committee related to the Companion Clinic Program or the matching process?

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