MWC Foundation Mentor Application

The Minority White Coat Foundation is offering mentorship to individuals at all levels (elementary to graduate) and all stages (gap-year, already out of school, or just need guidance in the field) in hopes to increase minorities entering into the various fields of healthcare.

Requirements/Commitment:

Meet (in-person or online) with mentee monthly to discuss career goals and progress (This should be scheduled in advance according to what day and time works best for both)
Lead the relationship by initiating follow-ups and drive the development of the mentee
Document your meetings with your mentee. A form will be provided to you from the foundation so that we stay consistent with each goal
Maintain confidentiality regarding shared information
Participate in an evaluation of the program annually (brief survey)

I understand the requirements and commitment to become a mentor: *

Yes, I understand

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

What field of Healthcare do you work in or currently studying? *

Do you have a preference to mentor an individual at a specific education level? Please indicate here: *

Ex: Elementary, High School, Undergraduate, Graduate/Post-Bacc, Graduated and need guidance in the field, No Preference

Please indicate your the maximum number of mentees you can handle:

Please provide us with more information about your previous skills in mentoring: *

How can you help impact someone's dream looking to enter into Healthcare? *

Please upload your resume/CV:

Browse Files

Files can be uploaded in PDF or Microsoft Word.

Help us to match you!

Statistics show that people, in general, respond better to those of the same gender, race, and ethnic group. The following questions do not impact you being a mentor in any way but help us to match you with a mentee with similar background and preferences.

Do you consider yourself to be underrepresented in healthcare? *

Yes No

Ethnic Origin:

Hispanic Non-Hispanic Not Indicated

Race? (Select one or more):

Black or African American Latinx Asian Native American or Alaskan Native or Native Hawaiian or Other Pacific Islander Two or more races, when one or more are from the categories listed above

Preference of Communication

How would you describe your personality? *

How do you want connect with your mentee? *

In-Person Online Both - depends on our schedules

How do you prefer communication? *

Text Email Either is fine!

Which statement best describes your flexibility in meeting with your mentee? *

I can only commit to the monthly requirements I can meet with my mentee more, if necessary

When you think about communicating with your mentor/tutor, how do you envision the relationship? *

More casual – we will contact each other when we want to talk, knowing that the other person will be available for me when needed. More structured – we will schedule phone calls, e-mails, or personal meetings to ensure we keep up with one another.