HBIC Award Potential Mentors Please complete this form to signal your interest in serving as a mentor for the HBIC 2023 Award Competition. View the HBIC Mentor FAQs Visit the HBIC Award overview pageName * RequiredPlease enter your name First Middle name or initial (if pertinent) Last Institution * RequiredPlease enter the name of the institution from which you are offering to base your mentorship.Online profile * RequiredPlease provide a link to your online profileInstitution or lab (optional)Please provide a link to the website of the institution or lab from which you are offering to base your mentorship.Research interests * RequiredPlease provide keywords that describe your research interests, specifically those you would like to pursue through a mentorship project.Email * RequiredPlease enter the email address you would like the HBIC team to use to communicate with you. Enter Email Confirm Email Email for potential applicants (optional)If different than the email provided above, please enter the email address you would like potential HBIC award applicants to use to contact you to propose a mentorship project. Society Affiliation * RequiredPlease indicate with which HBIC Award sponsor society you are affiliated.ISBM (International Society of Behavioral Medicine) or ISBM member societyIBTN (International Behavioural Trials Network)SfHP (Society for Health Psychology of the American Psychological Association)APS (American Psychosomatic Society)SBM (Society of Behavioral Medicine)DGVM (German Society for Behavioral Medicine and Behavioral Modification)Availability for the 2023 Award Competition * RequiredPlease indicate whether you are available to take on a mentor as part of the 2023 HBIC Award competition.YesNoInclusion on the list of potential mentors * RequiredPlease confirm that you wish your name, institution, and email to be listed on the HBIC Award webpage as a potential mentor.YesNo Δ