Mentor Application - ACHE of Minnesota

First Name*

Last Name*

What is your current status in ACHE?*

Address*

City ZIP / Postal Code

Phone*

Email*

What is your current title/position?*

What organization do you work in?*

Level of professional experience?*

Preferred method of meetings?*

How often would you like to be in contact with mentee?*

Would you be open to group mentoring?*

Two mentors are matched with 3-5 mentees for group mentoring sessions.

Please attach a copy of your resume.*

Do you have additional preferences that you would like us to consider?

Demographics

Collected for de-identified chapter reporting purposes.

Age Group*

Gender Identity*

Race*

Select all that apply

Ethnicity*

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