BTMT Fellowship Application

Welcome to Building Tomorrow's Mentors Today Fellowship Program. We are an Equal Opportunity Employer and committed to excellence through diversity. Please fill out the following information.

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Question 1:

Have you worked in Community Mental Health services in the past?

Question 2:

What is your comfort level in working in Community Mental Health services?

Question 3:

Have you had any experience working with the following state agencies -- DCF - Department of Children and Families DMH - Department of Mental Health DYS - Department of Youth Services DDS - Department of Developmental Services

Question 4:

Do you intend to work in Community Mental Health services after completing this program?

Question 5:

What is your interest working in Community Mental Health services?

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my employment being terminated.