The Innovation Collaborative - Mentoring Program Application
We are here to help you find the perfect mentor to achieve your professional goals. By completing this brief application, we can learn more about you and understand how to best support your mentoring experience. For questions or concerns, please reach out to Kathy McNeice at kathy@captaincares.org. If you wish to complete a Mentee Personal Inventory Assessment prior to this application, reach out to Kathy using the above email. Thank you!
Contact Information
Name
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First Name
Last Name
Work/Personal Email
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example@example.com
Organization
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Work Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work/Cell Number
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Please enter a valid phone number.
Do you have a LinkedIn? If so, please provide the URL.
Professional Background
What is your current professional role and what do you believe are your greatest professional strengths?
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Where do you see opportunities to expand your area of expertise?
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What are the main goals you want to achieve through mentorship? Provide up to three main goals. We are excited to hear your perspective!
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Learning Journey
How would you prefer to communicate with your mentor?
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What feedback style works best for you?
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In three years' time, where do you see yourself professionally?
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Please provide a list of your top passions for both work and leisure time.
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What are some of the challenges you are currently facing in your role? How are you working to overcome them?
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What are the qualities you consider important in an ideal mentor?
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Submit
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