DoSAA fellowship 2019 (Mentor)

Application to Become Mentor

Mentor duties include: Collaborate with student fellow to talk routinely on phone/Skype for 2 - 4 hours per month between June and August. The Executive Committee will provide check ins/reminders to schedule these. Structure your mentorship around student 1-2 goals and general topics you think could be helpful for them. Guide fellow on a small summer project.

Mentors can be DoSAA professional members of any psychology discipline (Ph.D., Psy.D., M.S., M.Ed., MFT, LSW, etc.)

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* 1. Name

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* 2. Name of your current program/school or place of work

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* 3. Which state and time zone are you located in? Please write full names.

State:

Time Zone:

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* 4. What is educational background/training?

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* 5. Please share your current profession and indicate what roles (e.g., a. clinical, research, teaching, supervision, administrative, consulting) you are involved in:

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* 6. What stages/concerns of student careers would you feel comfortable mentoring? (Select all that apply)

Working clinically in the domestic violence field

Working clinically with South Asians

Apply/navigating a masters program

Exploring career goals as a master program graduate

Navigating dissertation process

Professional development

Career and identity integration

International student concerns (clinical, research, professional development, job search)

Intersections of identity concerns

Culturally informed research and clinical work

Working/providing services in a integrated health care model/ setting

Self-care

Vicarious trauma

Neuroscience

Mind/body interventions

Gender/sexuality related work

Religion related work

Navigating culture and ethics

Working, understanding, evaluating, and narrowing areas of research and community interest

Challenges as trainee in program, practicum, etc.

Internship, job, post doc search

Advocacy

Leadership in local/national level

Dissertation/thesis

Other (please specify)

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* 7. How many mentees are you willing to be assigned to

Other (please specify)

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* 8. Are you a DoSAA member?

Yes

No but I am willing to become a member by the start of the program

DoSAA fellowship 2019 (Mentor)

Application to Become Mentor

Question Title

* 1. Name

Question Title

* 2. Name of your current program/school or place of work

Question Title

* 3. Which state and time zone are you located in? Please write full names.

Question Title

* 4. What is educational background/training?

Question Title

* 5. Please share your current profession and indicate what roles (e.g., a. clinical, research, teaching, supervision, administrative, consulting) you are involved in:

Question Title

* 6. What stages/concerns of student careers would you feel comfortable mentoring? (Select all that apply)

Question Title

* 7. How many mentees are you willing to be assigned to

Question Title

* 8. Are you a DoSAA member?

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* 9. What name would you like us to use to introduce you as a program mentor to the fellows and the DoSAA listserv?

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* 10. Please provide your email address to contact you and any additional information you would like to provide to help our match process.