Welcome to the NYSPMR Mentorship Questionnaire!
Our aim is provide quality career guidance for those trainees interested in PM&R residency, fellowship, and job opportunities within the NYC metro area. 

We're excited to have you on board as a prospective Mentor!
First Name: *

Last Name: *

Phone number? *

Areas of interest within PM&R or Subspecialty *

(Please state your primary area of focus: General rehab, inpatient, sports medicine, MSK, Interventional pain, TBI, SCI, spasticity, cancer, pediatric rehab, etc)
Please indicate your level of training/experience *

What is your affiliated academic institution? *

(If no academic affiliation, please indicate name of private practice, or other inpatient/outpatient place of work)
Professional Title (IE –  Associate Professor, Chair, Director, etc.)

Are you able to provide research opportunities prospective to mentees? *

(Please indicate current/potential areas of PM&R research)
Location of practice? *

Our mentorship program spans over the course of a full academic year.  Are you able to commit to communicating and providing guidance to your mentee for this duration? *

This may include ~ monthly contact via email/phone plus in-person meetings as appropriate.
Serving as a mentor will entail ~ monthly contact via emai;l/phone plus intermittent in-person meetings as appropriate.  With this in mind, how many mentees would you be willing to mentor? *

Thank you for completing our mentorship questionnaire! 

We will be contacting our mentors soon with further information regarding mentorship guidelines and matching with prospective mentees for the upcoming academic year.

If you have any specific questions, please send us an email at nyspmrmentorship@gmail.com

Please visit the New York Society of PM&R homepage for details about future meetings, workshops, and educational opportunities.


Have a great day!

Thanks for completing this typeform
Now create your own — it's free, easy, & beautiful
Create a <strong>typeform</strong>
Powered by Typeform