ICA Mentorship Program Application 2021-2022

Indiana Counseling Association (ICA) Mentorship Program Application

Deadline for Submission: November 1, 2021
The Indiana Counseling Association Mentorship Program is an all-inclusive, multicultural leadership development opportunity for early professional counselors and seasoned professional counselors in the state of Indiana. The intent of this program is to advance the counseling profession through the engagement of meaningful conversations, the achievement of overarching goals, and shared wisdom that supports continuous career development and lifelong learning. Currently, we are seeking mentees and mentors who would be interested in joining this program.

Requirements
- Mentors must hold an advanced degree (master's level or higher) and have a minimum of five years' experience in professional counseling
- Mentees must be an ICA first- or second-year graduate student or Associate-level licensed professional (working toward independent licensure) and must be in good professional standing
- Mentors and Mentees must complete the Professional Identity Scale In Counseling (PISC)- provided in this application
Program Structure
- The ICA Membership program will review each interest form and carefully match mentors and mentees based upon research interests, demographics, and availability
- Mentors and mentees will be supplied with one another's contact information
- Mentors and mentees will meet once a month for approximately 45-60 minutes per session
- Mentors and mentees will be asked to fill out a brief program evaluation at the midpoint and conclusion of the program
- Mentors and mentees understand this is a voluntary opportunity; therefore, no compensation will be provided for participation
The mentor is not intended to replace -- or supplement -- the mentee's formal supervision.

The Indiana Counseling Association Mentorship Program has been adapted by the American Counseling Association’s Mentorship Program Guidebook 2020-2021. Therefore, this program has been designed to uphold ACA’s core values, mission, and vision. This includes but is not limited to promoting diversity, inclusivity, and professional development. The Indiana Counseling Association is indebted to the individuals who spent time developing this program and creating a foundation for proactive leadership.
Identifying Information
Name *

First Name Last Name
Preferred Gender Pronouns *
Cultural or Ethnic Identity *
How important is it for you to be matched with a mentor/mentee with the same cultural or ethnic identity? *

Not important Sort of important Very important
Contact Information
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email address *
example@example.com
Phone number *
Please enter a valid phone number.
Are you a member of the Indiana Counseling Association (ICA)? *
Education and Licensure
What is your highest degree obtained or presently working toward? *
Major Course of Study *
Institute(s) of Higher Education *
Graduation Date (if a student, please list projected graduation date):
Are you licensed as a professional counselor? *

Yes No
If yes, what license do you hold?
What is your counseling speciality area? (For example, multiculturalism, advocacy, autism, play therapy, couples and families, children with disabilities, education, etc).
What are your research interests? *
Application
What position are you applying for? *

Mentee Mentor
Statement of Interest (Describe why you are interested in joining this program). *
Goals of Involvement (Describe what you hope to gain for participating in this program). *
Please upload your most recent resume or CV to this application *

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Professional Identity Scale In Counseling (PISC)

This inventory is developed to assess your thoughts and beliefs about the counseling profession and your professional identity. Directions: Please read each statement carefully. Indicate your agreement in the space provided by typing the number that best fits with your thoughts. Please use the scale provided below for reference. (Woo & Malik, 2015)
1. I am knowledgeable of the important events and milestones (e.g., establishing ACA, state-level licensure) in counseling history. *
2. I am familiar with accreditation organizations (e.g., CACREP: Counsel for Accreditation of Counseling & Related Educational Programs) and their standards for professional preparation. *
3. I am familiar with certification organizations (e.g., NBCC: National Board for Certified Counselors) and their requirements for credentials. *
4. I am familiar with professional counseling associations (e.g., ACA: American Counseling Association) and their roles and accomplishments in the profession. *
5. I am knowledgeable of professional counseling journals (e.g., JCD: The Journal of Counseling & Development, journal(s) relevant to my specialty area) and their contents foci and purposes in the profession. *
6. I am able to distinguish the counseling philosophy from the philosophy of other mental health professions (e.g., counseling psychology, social work, and psychiatry). *
7. I will/have completed professional training and standard education to perform my duties in my roles. *
8. I have professional knowledge and practical skills required to successfully perform my roles. *
9. I am knowledgeable of ethical responsibilities and professional standards relevant to my roles. *
10. I value the advancement and the future of my profession. *
11. I am satisfied with my work and my professional roles. *
12. As a counseling professional, I share my positive feelings (e.g., satisfaction) when working with other people in other fields. *
13. I actively engage in professional counseling associations by participating in conferences and workshops every year. *
14. I advocate for my profession by participating in activities associated with legislation, law, and policy on counseling on behalf of the profession. *
15. I keep in contact with counseling professionals through training and/or professional involvement in counseling associations. *
16. I keep involved in ongoing discussions with counseling professionals about identity and the vision of my profession. *
Please verify that you are human *
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Indiana Counseling Association (ICA) Mentorship Program Application

Identifying Information

Contact Information

Education and Licensure

Application

Professional Identity Scale In Counseling (PISC)