Mentor Application

 

California Physical Therapy Association, CPTA

Student Mentor Program

Mentor Application

PURPOSE: To provide students with guidance on getting, and staying involved in activities in the San Jose District, CPTA, and APTA and act as a liaison and/or assist in the transition from student to clinician.

THE MENTOR SHALL:

  1. Introduce the student to activities within the CPTA.

  2. Serve as a role model.
  3. Initiate introductions and interact with student members at professional meetings.
  4. Serve as a resource for questions.

QUALIFICATIONS:

The mentor must be an Active, Affiliate, Graduate Student or Life member of the CPTA and interested in promoting the PT profession.

PROCESS:

  1. Mentor will send in Mentor Application to the Chapter Executive Office.

  2. Membership Program Staff Manager and Program Coordinator will make assignments and provide mentor with the student's name and other appropriate information.
  3. Mentor will contact assigned student.
  4. Chapter Executive Office Staff will send evaluation forms to participants at the end of the school year.

HOW DOES IT WORK:

  1. CPTA student members will be provided with the opportunity to participate in the program.

  2. Interested students should submit a Mentor Program Application.
  3. Membership Program Staff Manager and Program Coordinator will verify membership and make mentor/mentee assignments.
  4. A master list will be kept in the Chapter Executive Office of all mentors and students.
  5. District Student Liaisons will receive a copy of the mentors and students for their District.
  6. No more than 2 students will be matched with any one mentor.

WHY GET INVOLVED:

  1. To assist students in the transition from PT or PTA programs to professional involvement in the APTA.

  2. To serve as an information source for PT or PTA students establishing themselves within the profession.

For more information please submit the online form below or contact Julie Carpenter in the Chapter Executive Office at TEL: (800) 743-2782 or (916) 929-2782, FAX:(916) 646-5960 or email: Stacey Defoe

 
What is your name?

What is your APTA membership number?

What is your APTA local district?

What is your phone number? (Please include area code.)

What is your fax number? (Please include area code.)

What is your email address? (Please include area code.)

I am a:

Are you willing to act as a mentor to a PTA student?
Yes
No

Are you willing to act as a mentor to a student from another District?
Yes
No

Please indicate areas of practice:
Ortho
Sports Medicine
Administration
Pediatric
Neuro
Acute Care
Hand Therapy
Geriatrics
Education
Private Practice
Other

Feel free to enter any comments.

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