AADPRT Training Director Mentorship Program Interest Form

AADPRT Training Director Mentorship Program Interest Form

We're excited you're interested in connecting with other AADPRT members to develop a fruitful mentorship experience! Mentors and mentees can work together to discuss career development, troubleshoot workplace politics, brainstorm practical work/life strategies, or just about anything else. Please answer the questions below to help us match you with the right mentor or mentee.

Recommended Experience to be a Mentor: Asst/Assoc Training Director - at least 2-3 years; Training Director - at least 3 years

Narpinder Malhi, MD
Chair, Mentorship and Professional Growth Committee

Name

First NameLast Name

Program name

Program size (# of residents/fellows)

Program type

Other

Program setting

City/State

Street Address

Street Address Line 2

CityState

Phone (must include valid area code)

Please enter a valid phone number.Format: (000) 000-0000.

Email

Confirmation EmailConfirm Email

Program category

Current position

Number of years in current position

Number of years in education leadership (i.e. any of above roles)

I'm interested in being a

Mentor Information

To best help us identify an appropriate mentee for you, please fill out the below information. If you are an Assistant or Associate Training Director, we recommend that you have had at least 2-3 years in the position before becoming a mentor. If you are a Training Director, we recommend that you have had at least 3 years in the position before signing up to be a mentor.

Please indicate the maximum number of mentees you would be willing, able, and interested in working with in a 1:1 mentorship relationship.

As a Mentor, please check area(s) in which you feel you could be helpful.

Would you be interested in mentoring a group of mentees interested in exploring a specific topic from the list below? (if interested in a particular topic, please list in other)

As a Group Mentor, please check area(s) in which you feel you could be helpful.

Is there anything else you could tell us about you that may help us pair you with the right mentee (e.g. particular interest, background, life experience)?

Mentee Information

To best help us identify an appropriate mentor for you, please fill out the below information.

As a Mentee, please check the area(s) you are looking to be mentored in

Gender preference

Preference for your mentor's career stage (check all that apply)

Time zone preference

Diversity/Inclusion preference (check all that apply)

Underrepresented minority description

I prefer my mentor to be a:

Preferred contact frequency

Other

Are you also interested in group (like-minded mentees paired with a mentor based on particular theme/task) or peer (like-minded mentees working with and mentoring each other on particular theme/task) mentoring?

As a Group or Peer Mentee, please check the area(s) you are looking to be mentored in

Is there anything else you would like to tell us about yourself that may help us pair you with the right mentor (e.g. particular interest, background, life experience)?

Is there anything else you would like to tell us about yourself that may help us pair you with the right mentee (e.g. particular interest, background, life experience)?

Thank you!