2022-2023 Mentorship Application
I want a mentor!
Date
*
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
School
*
Year in school
*
How did you hear about the mentorship program?
*
The Brunch
A Friend
Our Website
Other
Have you attended the Black Nurse Brunch before?
*
Yes
No
Tell us about yourself..
*
Why do you want a mentor?
*
What do you wish to gain from this experience?
*
What are your post-grad dreams/goals?
*
What areas do you want help in?
*
My senior year!
NCLEX Prep
General assistance
Career Readiness
Other
If you listed other, please explain
I can commit to monthly meetings, check-ins, activities with my mentor?
*
Yes
No
Unsure
Any additional things you would like us to know..
Submit
Should be Empty: