NOBIDAN MIG Mentee Application

NOBIDAN Mentee Application
Name

First Name Middle Name Last Name
Credentials
Academy Member Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Are you a current NOBIDAN member? If so, what membership category?

Student Active Not a current NOBIDAN member
Email
example@example.com
Cell Phone Number

Area Code Phone Number
What is your racial/ethnic background? Check all that apply.

Black / African American American Indian / Alaska Native Asian Hispanic / Latino Middle Eastern or North African Native Hawaiian / Other Pacific Islander White or Caucasian I prefer not to disclose this information
What discipline/specialty would you like your mentor to specialize in? Check all that apply.

No preference Business/Industry Clinical Nutrition, General Communication/Publication Community Nutrition Consultation and Private Practice Diabetes Care Education Food and Nutrition Management/Administration Food Service Gerontology Integrative/Functional Nutrition Long-Term Care Nutrition Support Oncology Pediatric Policy/Advocacy Renal Nutrition Research School Nutrition Weight Management Wellness/Prevention
What areas are you seeking guidance in? Check all that apply.

Dietetic Internship/RD Exam Support Job Opportunities/Networking Resume Guidance/Interviewing Skills Management/Leadership Skills Academic Support General Career Guidance Social Media/Technology Career/Student Challenges with being a minority
What stage are you in your career/academics? Check all that apply.

Student - Undergraduate Student - Graduate Dietetic Intern New RD (less than 5 years in the field)
What is your preferred method of communication? Check all that apply. (Note: While the Mentorship Program Committee will do our best to match mentors and mentees that are in the same geographic area, it is likely that the mentor and mentee will be in different locations and maintain their relationship by other means of communication.)

Email Text Message Phone Calls Virtual Meeting such as Skype, Google Hangout, etc.
If you prefer a virtual meeting, what platform(s) are you familiar with? Check all that apply.

Zoom Skype Google Hangout Google Meet WEBEX GoToMeeting FaceTime
How comfortable are you with technology?

Very Comfortable Comfortable Neutral Uncomfortable Very Uncomfortable
What do you hope to gain from participating in this mentorship program?

0/200
Is there anything else you would like to share to assist with matching you with an ideal mentor?

0/200
Should be Empty:

NOBIDAN Mentee Application