CAPA Mentorship Program: Mentor Questionnaire

Program Overview:

The CAPA Mentorship Program spans approximately six months, with mentors typically matched with one to two mentees. There is no minimum number of required hours per month, as we recognize that schedules vary. Instead, we encourage mentors and mentees to establish regular, meaningful interactions that best support the mentee’s goals.

Many mentor–mentee connections operate on a needs-based schedule, allowing both parties to determine how often they meet. Interactions may include virtual or phone meetings, email check-ins, or in-person meetings when logistically feasible.

Mentors may also provide support with practical career development tasks such as résumé reviews, mock interviews, and feedback on employment contracts or practice agreements.

We welcome any CAPA member who is eager to share their knowledge and experience.

Please complete the questionnaire below to help us understand your preferences and find the most suitable mentee match for your schedule and goals.

Fields marked with an * are required.

First Name *

Last Name *

Email *

Phone *

City *

Professional Designation *

PA Program *

If you selected other, please list the program

Graduation Date *

Preferred Meeting Times *

Please check all that apply

Mornings (before noon)

Lunch time (between 12 - 3pm)

Evenings (after 5 pm)

Weekends (Saturday or Sunday)

No preference

Preferred Method of Communication *

Please check all that apply.

E-mail

Phone (text included)

Zoom or Teams

In-person

How frequently would you like to meet with your mentee? *

Please select all that apply.

Weekly

Biweekly

Monthly

As needed

Do you prefer an early career PA, recent graduate, or current PA student to mentor? *

Please check all that apply.

No preference

Early career PA (less than 5 years)

Recent graduate (not licensed)

Current PA Student

Are there any personal values or characteristics that are important to you in a mentee?

What area of health do you practice in? *

General/Family Medicine

Primary Care

Internal Medicine

Emergency Medicine

Surgical Subspecialty

Other

If other, describe

Personal Statement

Please briefly tell us about yourself, past professional experiences, and personal interests.

Current CAPA Member? *

Participation in the CAPA Mentorship Program requires both mentees and mentors to be current CAPA members. This helps highlight the value of professional membership. If you’re not yet a member, we encourage you to join CAPA and take part in mentorship.

Please verify that you have checked the “I'm not a robot” checkbox.

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