NOBIDAN Mentor Application
Academy Member Number
Street Address Line 2
State / Province
Postal / Zip Code
Are you a current NOBIDAN member? If so, what membership category?
Not a current NOBIDAN member
Cell Phone Number
What is your current or last area of practice?
How long have you practiced in your field?
What is your racial/ethnic background? Check all that apply.
Black / African American
American Indian / Alaska Native
Hispanic / Latino
Middle Eastern or North African
Native Hawaiian / Other Pacific Islander
White or Caucasian
I prefer not to disclose this information
What is your area of expertise or focus? Check all that apply.
Clinical Nutrition, General
Consultation and Private Practice
Food and Nutrition Management/Administration
What type of guidance can you provide? Check all that apply.
Dietetic Internship/RD Exam Support
Resume Guidance/Interviewing Skills
General Career Guidance
Career/Student Challenges with being a minority
If you had a choice, who are you most comfortable mentoring? Check all that apply.
Student - Undergraduate
Student - Graduate
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.)
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.
How comfortable are you with technology?
What do you hope to gain from participating in this mentorship program?
Is there anything else you would like to share to assist with the matching process?
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