2017/18 Mentorship Program Mentee Profile Form

Thank you for your interest in being a mentee for the 2017-18 Emerging Health Leaders Mentorship Program. Please complete the form below with your information and responses.

Please note, we only have 30 spots open for mentees at this time. You may still submit your profile after this quota has been reached and will be added to the waiting list. If any spots become available, you will be contacted to participate.

Once you have completed the form, you will be redirected to register for the Mentorship Kick-Off event on April 6, 2017 to complete your registration as a mentee. There is a $50.00 registration fee to participate in the program. This fee covers your registration for:

  1. Mentorship Kick-Off event
  2. Goal setting seminar with your mentor
  3. Midpoint check-in and
  4. Year end mentorship appreciation.

Thank-you for your interest!

Mentee Profile Form
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