IAABC Approved Mentor Application

Contact Information

Name

Street Address

City ST ZIP Code

Home Phone

Work Phone

E-Mail Address

Availability
During which hours are you available for mentoring? ___ No preference
Weekday mornings	Weekend mornings
Weekday afternoons	Weekend afternoons
Weekday evenings	Weekend evenings

Interests

Tell us in which areas you are interested in mentoring

Tutorials

Mentoring of IAABC members on the path to certification

Mentoring by email

Mentoring by phone

In-person mentoring

Areas of Expertise

Summarize your background including education, employment, volunteering and other activities, including hobbies or sports that helped you develop your knowledge, skill and ethics base:

Liability Insurance

Have you checked with your insurance carrier to see if you are covered as a supervisor/mentor?

IAABC Certification – in what division(s) are you certified? What are your prime areas of interest?

Parrot ___ Dog ___ Cat ___ Working Animals

Service Animals ___ Therapy Animals ___ Search & Rescue ____

Other __________________________________________________

Areas of Competency - as a Certified member of IAABC you have proficiency in the five core areas of competency. But what are your areas of greatest strength?
	Assessment & Intervention Strategies – with what species?
	Counseling Skills & Social Systems Assessment – understanding & intervening in complex human systems including the family, community, healthcare system
	Behavioral Science – the capacity to understand and apply scientifically derived fact, theory and skill related to animal development & animal behavior problems (includes theories of learning
	General knowledge of animal behavior/ ethology
	Species-specific knowledge: healthcare, nutrition, husbandry, behavior

Agreement and Signature

By submitting this application, I affirm that the facts set forth in it are true and complete. I understand that if I am accepted as an IAABC Approved Mentor, I will continue to abide by the IAABC Code of Ethics and Practice Guidelines. I give my permission a summary of this information to be made available to prospective mentees:

Name (printed)

Signature

Date

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in serving as a Mentor.

Please return the form by email to kc@texasdogtrainer.com or mail to IAABC, Inc., c/o Kathie Compton, P.O. Box 516, Marfa, TX 79843