Therapist Mentoring Program - Mentee Survey

Thank you for your interest in the Cure SMA Therapist Mentoring Program. Please fill out the form below to indicate your interest in becoming a mentee, and a coordinator will be in touch with you shortly. Also, depending on your browser's settings, the alignment of questions and answers may be off slightly.

  Basic Information

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Name:

 

 

   

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City:

 

    

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What's this?

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Question - Required - Degree and/or licensure (check all that apply):
Please make at least 1 selection from the choices below.

 

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* Setting:
(Select one of the available choices or enter a different value.)



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Question - Required - Rate your familiarity with the Hammersmith Infant Neurological Examination (HINE) (infant to early childhood)




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Question - Required - Rate your familiarity with the Hammersmith Functional Motor Scale -- Expanded (HFMSE):




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Question - Required - Rate your familiarity with the Revised Upper Limb Module test (non-ambulatory members) (RULM):




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Question - Required - Rate your familiarity with the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-Intend):




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Question - Required - Rate your familiarity with the six-minute walk test (ambulatory):




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Question - Required - Rate your familiarity with the swallow study:




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