FAANP Mentorship Program Application

Please fill out the following application, along with one NP Professional Reference Supporting Statement and submit them to mentorship@aanp.org. For the Mentee applicant to be considered, the deadline to submit this completed document is February 6, 2019.

You do NOT need to find a mentor on your own. Should you be selected, the Mentorship Committee will match you with a Fellow who has volunteered for mentorship and has the background and skills to best assist you. We will notify you within two weeks of the close of applications.

If you are selected, your project will begin around the time of the AANP National Conference. However, once you and your mentor have contacted one another, it is a good idea to have a discussion regarding scope of the project and the achievable, measurable objectives for the project.

First Name is required
Last Name is required
Credentials is required
Specialty is required
Address is required
Phone is required
Email is required and must be in the format email@domain.com
Practice Setting is required
How long have you been practicing as a nurse practitioner is required
Why I want to enter the mentorship program is required
Have you presented this potential mentorship project to your supervisor and what was the result of the conversation? is required
Securing a mentor IS NOT required prior to application. Remember that the mentor MUST be a Fellow. Some applicants have taken the step to discuss their project with a Fellow who is a possible mentor. If you have done so, please answer the following questions:
Have you discussed the project with a Fellow before you’ve made application for the project? If so, with whom? Has this Fellow agreed to the mentorship? is required
Please provide current contact information of the Fellow who has agreed to your mentorship if such an agreement predates the submission of your application. is required
Specific Area for Development is required
In your selected category above, please choose a corresponding development area using the options below:
Provide a brief, specific descriptions of the one selected focus you indicated above. Specifics should identify the unique area for development. is required
Provide a brief, specific descriptions of the one selected focus you indicated above. Specifics should identify the unique area for development. is required
Provide a brief, specific descriptions of the one selected focus you indicated above. Specifics should identify the unique area for development. is required
Objectives for Project
You have described the specific area for your project. Below, please develop three attainable, measurable and project-centered objectives.
Objective 1 is required
Objective 2 is required
Objective 3 is required
By signing and submitting this application, you agree to the following items: a) everything in this application is accurate, to the best of my knowledge; b) the timeline and expectations set forth by the FAANP Mentorship Program; c) should I be selected, attendance of the Mentorship Orientation at AANP’s National Conference; d) should I be selected and my commitment to the program changes, I will notify FAANP staff at faanp@aanp.org.
Name is required
Date is required