Mentee ApplicationMentee ApplicationFirst Name*Last Name*What is your current status in ACHE?*Student MemberMemberFellow (FACHE)RetiredLife Fellow (LFACHE)Address* City ZIP Code Phone*Email* What is your current title/position?*What organization do you work in?*Level of professional experience?*New Professional (<5years)Mid-Level Professional (5-15 years)Senior-Level Professional (>15 years)Preferred method of meeting?* In person Phone Virtually AnyHow often would you like to be in contact with mentor?* Once every 2 weeks Once monthly Once quarterly As neededWould you be open to group mentoring?*Two mentors are matched with 3-5 mentees for group mentoring sessions.YesNoUpload Resume*Max. file size: 64 MB.Describe your plans for professional development.*How do you expect the mentorship program will contribute to this plan? How do you expect to use this experience in your current and future roles?Is there anything else you would like us to know?DemographicsCollected for de-identified chapter reporting purposesAge Group*<2525-3435-4445-5455-6465+Gender Identity*FemaleMaleIntersexPrefer not to answerRace*Select all that apply American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White or Caucasian Two or more races Prefer not to answerEthnicity*Hispanic or LatinoNot Hispanic or LatinoPrefer not to answerCAPTCHAΔ
