Mentee Application

If you would like to obtain a mentor, please complete the following form. Once received, we will match you up with a mentor that best suits your needs. Please feel free to contact us at 401-524-3074 if you have any questions.

The Mentoring Program is for educational purposes only. Participants agree that they will not rely on this information while treating patients or providing other professional services.

Contact Information
Name*
First Last
Email*
Work Phone
Degree
Company
Current Position (Role/Title)
Work Address
Street Address City State / Province / Region ZIP / Postal Code Country
Education / Certifications / Specialty
Medical School*
Residency / Graduate Training*
Post Residency / Post Graduate Training*
Board Certification*
How many years have you specialized in the addiction field?*
Years of Experience in Psychiatry*
Type of Practice Setting (check all that apply)*
- Academic
- Private
- State/Federal
- Inpatient/Outpatient
- Mixture of Inpatient/Outpatient
- Methadone clinic
- Intensive Outpatient Programs
- Residential Program
Mentor Info
Ask A Colleague—an opportunity for mentees to pose a question through an online portal and receive advice from a clinical expert and/or colleague. Click here to ask a colleague now.
Mentoring—provides individualized, one-on-one guidance to discuss specific clinical issues and/or career and life challenges.
Clinical/ Research Interests
Is it important for your mentor to be geographically nearby?*
What do you hope to gain from mentoring program?*
I prefer a mentor with experience in...*
Special Interests (e.g. family/life balance, hobbies, talents, pets etc)
Preferred Mentors
Mentees are encouraged to browse through the mentor directory and choose their top three mentors: Please indicate who your top three mentors are and we will do our best to match you.
Preferred Mentor #1*
Preferred Mentor #2*
Preferred Mentor #3*
I understand and agree that all information that I receive through the AAAP Mentoring Program is for educational purposes only, and that I will not rely on this information when treating patients or providing other professional services. I understand and agree that AAAP is not responsible in any way for any treatment or services that I provide based on information that I receive through the AAAP mentorship program, and I agree to indemnify and hold harmless AAAP for any claims related to services that I provide.

Mentee Application

AAAP Mentoring Program

Contact Information

Education / Certifications / Specialty

Mentor Info

Preferred Mentors

Get involved.
Join AAAP today.

Learn more about The American Journal on Addictions

Mentee Application

AAAP Mentoring Program

Contact Information

Education / Certifications / Specialty

Mentor Info

Preferred Mentors

Get involved. Join AAAP today.

Learn more about The American Journal on Addictions

Get involved.
Join AAAP today.