LAHIDAN Mentoring Program
Mentor Sign-up
Name
First Name
Last Name
Academy Member Number
Have you matched with a LAHIDAN Mentee in the past?
*
Yes (If so, we will use your information from previous years. Please update contact information below if necessary. Thank you!)
No (If you have not been matched with a mentee through LAHIDAN before, please complete the information below.)
If yes to question above: Are you still in touch with your previous mentee? Write a paragraph summarizing your experience.Your answer
City & State
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation and/or Title
Organization/Employer
Brief Job Description
Where did you complete your dietetics program?
What internship program did you complete?
How many hours per month can you commit to mentoring?
1-2
3-4
In matching you with a mentee, is there anything else you would like for us to take into account?
Which track(s) would you prefer to be a part of?
Track 1: Internship application - 4 months duration, November-February15th
Track 2: Pre-internship application - 1 year duration (best for students 1-2 years away from applying for the internship)
Track 3: Career development - 1 year duration (best for interns or new professionals with less than 1 year experience)
Please attach your resume or cover letter to better understand you career background
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This is not a requirement
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