TSHP Mentor Application

Your Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

TSHP Member

TSHP Member #

Thank you for volunteering to be a Mentor for the TSHP Mentorship Program. You have indicated above that you are not a current member of TSHP.

Since participation in this program is a member benefit, you will need to join the TSHP community. Visit the following webpage to determine your membership category: www.tshp.org/join. Please complete your membership registration by June 15th in order to be matched with a mentee.

Once you have completed your TSHP membership registration, please email bailey.nell@tshp.org your name and new member number, so we can can update your mentor application.

For any questions about membership or if you need assistance signing up please email membership@tshp.org.

Thank you!

TSHP Local Chapter

Unsure which you fall into, visit www.tshp.org/map.

Year you graduated

School/College of Pharmacy

Degree(s)

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Post Graduate Training

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Your Practice Area Interests as a Mentor

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Practice Experience/Career Path:

Hobbies/Other Activities:

Maximum number of mentees you would like to have:

How often would you be available to mentor?

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Mentee Geographic Preference:

Mentee School/College of Pharmacy Preference (if any):

Specific Mentee Request (indicate name):

Would you be willing to mentor a New Practitioner (a pharmacist who has graduated within the last 5 years)?

Please keep me on the Mentor list for the next cycle as well. Checking "Yes" below acknowledges that you agree to be automatically put on the mentor list again next year. By selecting "No", you will need to re-apply next year if you wish to participate.

Additional comments you would like the Matching Committee to consider:

In a successful Mentorship Program match, the Mentor and Mentee commit to working together.
By clicking submit below, you agree to put forth reasonable efforts to maintain agreed upon expectations set forth at the beginning of the match cycle. Each party should also understand that he/she may withdraw from the match at any time by contacting the TSHP Mentorship Program team at newpractitioner@tshp.org. Most of all, have fun! Read more tips & guidelines at www.tshp.org/Mentorship.

Academia
Acute Care
Ambulatory Care
Anti-coagulation
Association Management
Cardiology
Clinical Research/Investigational Drugs
Critical Care/Emergency Medicine
Drug Information
Geriatrics
Government Agency
Hematology/Oncology
Home Care
Imunology/Transplant
Infectious Disease
Leadership
Legislative Agency
Long Term/Chronic Care
Managed Care
Medical/Pharmaceutical/Scientific Publishing
Nuclear Pharmacy
Nutrition Support
Pain Management
Patient Safety
Pediatrics
Pharmaceutical Industry
Pharmacoeconomics
Pharmacoinformatics
Pharmacotherapy
Practice Management
Primary Care
Psychiatry/Neurology
Research
Specialty Certification
Toxicology/Poison Control
Uniformed Services
Other