Mentor Recruitment Survey

Thank you for your interest in being a mentor for the Mentorship On Demand program. Mentor registration is available for CAOT Members, CAOT Retired Members, CAOT Occupational Therapist Assistants and CAOT Individual Associates who are occupational therapist assistants. Please complete this brief survey so that we can learn more about you. Please download and complete this form prior to starting the survey. You will be asked to submit this form at the end.

First name: *

Last name: *

CAOT Member or Associate #:

Address:

Address Line 1

Address Line 2

City

Country

Province/State

Postal/Zip

Your contact information will not be disclosed until you are paired with a mentee.

What is your preferred email address? Please confirm that the email address is correct before proceeding. *

What is your preferred phone number?