SHAA Mentee Application
All applicants must be current SHAA members in good standing.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are you currently licensed in the state of Alabama?
*
Yes
No
Do you hold your Certificate of Clinical Competence (CCC)?
*
Yes
No
AUD
Current Employer
*
Years of Professional Experience
*
0–2 years
3–5 years
6–10 years
10+ years
Which category best describes you?
*
SLPA / AUDA
Early career professional
Professional transitioning to a new work setting
Student
CFY
Other (please describe below)
If you selected “Other,” please briefly explain why you are seeking a mentor.
What areas are you specifically seeking mentorship in?
Leadership
Academia
Minority mentorship
General Speech-Language Pathology
General Audiology
SLPA / AUDA support
Content-specific (e.g., Dysphagia, AAC, Voice, Fluency)
Private Practice
School-Based Practice
Other (please specify)
Is there anything else you would like SHAA to consider when pairing you with a mentor?
Please upload a copy of your resume.
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