Credentials: (degrees, licenses and certifications)
Areas of specialization and experience/populations worked with:
Number of years licensed:
Work site: (agency, private practice, university, etc.)
Previous experience being a mentor? If so, please explain:
Why do you want to be a mentor and what do you think you can offer a mentee?
- Email address
What ways are you are willing to be in contact with a mentee? Check all that apply:
If yes, what NYMHCA chapter do you belong to?
Before submitting your application, please respond below: (If you have not read the Mentoring Program Overview, click here.)
*After you submit your application, you will receive an email confirmation and will be asked to submit a CV by email. When your application and CV have been reviewed, you will be notified regarding the status of your application.
Thank you for your interest in mentoring our future professionals!