Grants will be awarded based on the answers
to these questions. Please be as thorough as possible.
Please identify which young member group this application/activity will be
targeting. You may choose more than one.
describe the mentoring program/activity.
How do you plan to sustain the program? What are your plans to longitudinally sustain the relationship between the mentee/mentor?
Time of the event or time frame of the activity:
Research has shown that rewarding the mentor for their efforts has helped with the sustainability of the mentor/mentee relationship. How do you plan to reward or encourage the mentor?
number of participants (mentees) for your planned activity?
(Young Physicians, Residents,
What type of needs assessment will your chapter perform as part of this activity?
How will you evaluate the success of this
activity, both long term and short term?
Has your chapter held any previous mentorship events or activities? If yes, please describe.
for the Activity:
The amount of the grant award will be based on your
proposed budget and the perceived need for funding.
indicate the amount of award requested for your activity (up to $1,000):
list a budget for the proposed activity. Include costs directly related to the
event as well as the cost of advertising the event to your targeted young member
describe any other sources of funding available to the chapter for this activity,
including chapter funds, if any.
A report on the success of the activity is required for any chapter
awarded a grant. A follow up form will be sent if the grant is awarded and will
also be available online. Please keep in mind that the follow-up form should include
feedback from participants.
Who will be responsible for this report?
This application has been reviewed and approved by the chapter president