Sankofa CNA Mentoring & Coaching Program Application
Thank you for your interest in the Sankofa CNA Mentoring & Coaching Program. This 12-week mentoring experience is designed to support CNAs and caregivers who are ready to grow personally and professionally. Because this is a small cohort experience (limited to 10 participants), we ask all interested applicants to complete this brief application so we can ensure the program is a good fit.
Basic Information
Full Name
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First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City & State
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Professional Background
Which best describes you?
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Current CNA
Nursing Student
Aspiring CNA
Caregiver for family member
Healthcare worker other role
How long have you been working in healthcare or caregiving?
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Not yet started
Less than 1 year
1–3 years
3–10 years
10+ years
Where do you currently work?
Thought-Provoking Questions
What inspired you to become a caregiver or pursue healthcare?
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What are some challenges you are currently experiencing as a caregiver or CNA?
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If you could improve one thing about your professional life right now, what would it be?
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What do you hope to gain from this 12-week mentoring experience?
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On a scale from 1–10, how committed are you to investing in your personal and professional growth right now?
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Not committed
1
2
3
4
5
6
7
8
9
Highly committed
10
1 is Not committed, 10 is Highly committed
Readiness & Accountability
9. This program requires weekly participation and engagement. Are you able to commit to attending weekly sessions?
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Yes
No
Maybe
Why is mentorship important for caregivers?
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What makes this the right time in your life to participate in this program?
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This is a 12-week mentorship program designed to support caregivers in personal and professional growth. Are you willing to actively participate and engage in the process?
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Yes
No
Payment Readiness
If accepted, are you prepared to invest in this program?
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Yes – Pay in Full ($297)
Yes – Payment Plan (3 payments of $110)
I need more information
What habit, mindset, or behavior must you change to grow?
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Describe a challenge you’ve faced in your caregiving or professional life and explain what you did personally to try to overcome it.
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What specific actions will you take over the next 12 weeks if accepted?
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Anything else Coach Suprena should know?
Submit
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