2022-2023 Scholarship Application

2022-2023 Mentorship Application

I want a mentor!
Date*

MonthDayYear
Date
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
School*
Year in school*
How did you hear about the mentorship program?*

The BrunchA FriendOur WebsiteOther
Have you attended the Black Nurse Brunch before?*

YesNo
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 PrepGeneral assistanceCareer ReadinessOther
If you listed other, please explain
I can commit to monthly meetings, check-ins, activities with my mentor?*

YesNoUnsure
Any additional things you would like us to know..
Should be Empty:

2022-2023 Mentorship Application