Customer Satisfaction Survey - PSC



Print FormOfficer InformationAPAOC Mentoring Program Application Form2019-2020Date:Last, First, MI Job Title Work Phone Email AddressParticipate as Mentor or Mentee MentorMenteeRank Agency/OPDIV CategoryYears of ServiceIf you currently have a mentor/ mentee that you would like to keep for the new program year, please providethe following information regarding your mentor or mentee. Otherwise leave blank if you would like a new match.Current Mentor InformationRank Last, First, MI Agency/OPDIV CategoryEmail AddressCurrent Mentee InformationRank Last, First, MI Agency/OPDIV CategoryEmail AddressIf you are participating as a mentor, please choose your areas of strength where you can provide mentoring:LeadershipPromotion PreparationNetworkingCareer path and optionGrant writingGoal gettingAdministrative skillResearch skillClinical skillOther (please list):Interpersonal and communication skillKnowledge about PHS and other federal agenciesIf you are participating as a mentee, please choose the areas where you are looking for guidance:LeadershipPromotion PreparationNetworkingCareer path and optionGrant writingGoal gettingAdministrative skillResearch skillClinical skillOther (please list):Interpersonal and communication skillKnowledge about PHS and other federal agenciesPlease choose your preference for the following questions:Pairing with officer of higher or same rank in the mentee/ mentor's categoryPairing via a multi-disciplinary approach such that mentors and mentees are matched according to perceived strengths & weaknessesAre you interested in being assigned more than one mentor? (for mentee only)Comment(s): ................
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