Name *

First Name

Last Name

Frequency of Working with Wheelchair Service Users *

Daily

Weekly

Monthly

Less than Monthly

How long have you been working in your professional field *

Less than 1 year

1-5 years

5-10 years

More than 10 years

How long have you been working in wheelchair provision/24-hour postural care *

Less than 1 year

1-5 years

5-10 years

More than 10 years

I agree to commit 2-5 hours per week for 10 weeks to this mentorship programme to facilitate knowledge and skill development *

Yes

No

I understand that Sharon Sutherland can terminate this mentorship programme at any time after one verbal warning if mentee is unwilling to participate, fails to schedule virtual meetings, or do not complete work as discussed, and that the mentee's sponsor will be notified of this termination *

Yes

No

I understand that this is a fully virtual mentorship and in-person hands-on training is not included *

Yes

No

I understand that performing a hands-on assessment with a patient/client/service user during at least one meeting with Sharon is a required part of this mentorship and I agree to this *

Yes

No