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SDIC APIC Mentorship Program 2024 Application
Thank you for your interest in participating in the SDIC APIC Mentorship Program 2024 cohort. Complete the following questions below to help facilitate the matching process.
Deadline reminders
Open application: January 10 - February 16
End of cohort 2023: February 23
Start of cohort 2024: March 1
Mid-Point Evaluation: August 1
End of cohort 2024: February 21
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Are you an APIC Member? (Participants must be an SDIC APIC member for the 1 year program)
*
Yes
No
Which role are you interested in?
*
Mentor
Mentee
Required
Are you CBIC certified?
*
No
CIC
a-IPC
LTC-IP
Required
How many years of experience do you have in the Infection Prevention field?
*
Less than 1 year
1 - 2 years
3-5 years
Greater than 5 years
5-10 years
10+ years
Other:
Select your employment healthcare facility type or specialty focus
*
Acute Care Facility
Skilled Nursing Facility
Other Long Term Care Facility
Ambulatory Care Facility
Public Health Agency
Psychiatric Facility
Maternity Services of Women and Newborn
Other:
Did you participate in the SDIC APIC Mentorship Program cohort 2023?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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