CFHA PCBH SIG Mentorship Connector: Application
The PCBH SIG Mentorship Connector aims to facilitate mutually beneficial relationships between PCBH leaders, experts, clinicians, and students within a networking and professional development context. The program broadens knowledge of the field of PCBH, and provides opportunities for paired or group mentorship for new and experienced Primary Care Behavioral Health professionals.

Please contact Rachael Woody Mark (Rachael.Woody@connectus.org) if you have any questions.

*This application should take 5 or fewer minutes to complete.

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What is your email?  *
Is this the best email to contact you? If not, please provide a secondary email below.
Full name and preferred pronouns. *
What is your preferred method of communication? *
How long have you been a member of CFHA? *
Describe your professional training and education. (i.e. Masters in Social Work, LCSW and CADC) *
What city/state/country are you currently working in? *
How many years of professional experience do you have? *
How many years of professional experience working in Primary Care Behavioral Health do you have? *
What is your current job title and place of employment? *
Select any areas of specialty in PCBH (as applicable): *
Required
Describe any other area(s) of special interest. *
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