Why Join the Msha Mentorship Project As a Student/Clinical Fellow?

WHY JOIN THE MSHA MENTORSHIP PROJECT AS A STUDENT/CLINICAL FELLOW?

o Be part of an exclusive group of young professionals (registration limited to first 15 applicants) o Obtain valuable career advice as you make decisions about your future o Learn tips to successfully manage work-life balance issues o Develop professional connections across generations o Strengthen your involvement in your state association

The Program will closely follow ASHA’s Mentoring Programming and Goals. You’ll be matched with a mentor based on your clinical interests and geographical location.

As a participant, connect with your mentor twice per month via phone, email, or in person over the next three months. Participants will receive monthly emails with tips/conversation starters to encourage discussion.

Questions about the program? Email [email protected] for more information MENTORSHIP PROGRAM - MENTEE APPLICATION

Name: Email address: Phone number: Languages spoken: Personal hobbies/interests: Please list your top three areas of interest: 1. 2. 3.

STUDENTS OR CLINICAL FELLOWS/EXTERNS Degree pursuing: Expected date of graduation (MM/YYYY): Current university: City of residence: Clinical population of interest: Future employment facility of interest:

I agree to participate in the MSHA Mentorship Program. By signing up, I am committing to be in contact with my mentor twice per month. I understand that my commitment will begin when matched with a mentor and will continue for a three month period.

Signed______Date______