The Leadership Initiative: Mentee Application

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Mentee Application Form

Please complete this application to apply for The Leadership Initiative. You may save your progress and resume at any time. Note: These applications are processed on a rolling basis. Once you submit ALL of your COMPLETED materials to us we will begin the process of matching you with a mentor.

Only complete applications will be considered, please include all of the following: 1) Applicant Information; 2) Resume; 3) Essay Questions; 4) Participant Contract; and 5) Supervisor Recommendation Form.

*The Supervisor Recommendation form can be downloaded here. It will need to be filled out by your supervisor and uploaded in Section 5 before your application can be submitted.

1. Applicant Information

First Name:

Last Name:

Job Title:

Agency:

Work Address:

City:

State:

Zip:

Work Phone:

Email:

Cell Phone:

Preferred pronouns:

Supervisor's Name:

How long have you worked at your agency?

How long have you worked in the human service sector?

How long have you worked in your current position?

Please list any certificates or credentials you have received:

Please describe your current position as well as any prior positions you have held at your agency. Be sure to highlight any progressive responsibility you have taken on during your employment at this agency:

Resume Upload

Please attach a copy of your resume to this application:

Essay Questions

Please answer each of the following four questions thoughtfully in not more than 300 words per question.

a) What are your career or professional development goals? What do you plan to do to achieve your goals?

c) Using the list below or your own additions, please identify the three skill areas which you most want to learn about through mentoring and explain how improving in this area will help you achieve your professional and career goals. (1) Operations - Recruiting, interviewing and hiring staff; Contract management and interpretation; Goal setting, strategic thinking and planning; Facilities management; Clinical requirements and outcomes; and IT and systems management. (2) Finance- Development, grant writing and fundraising; and budgeting. (3) Communications and Marketing- Public Relations; Oral and written communication; Marketing; Building external relationships. (4) Interpersonal Relations- Coaching and motivating staff; Team building; Conflict management; Delegation skills; Managing diversity. (5) Leadership- Leading and managing change initiatives; Promoting and implementing innovation in programs and services; Identifying and improving agency processes; Managing external and internal relationships; Negotiation; Giving and receiving feedback.

Additional Comments:

Supervisor Recommendation Form

Please upload the supervisor recommendation form, found here:

Participation Contract

Participant Qualifications and Roles for Mentees
Mentees will be Providers' Council member agency employees who:

Have been working in the sector for at least two years;
Have been with their current agency in a position with supervisory responsibilities or have otherwise demonstrated or shown interest in progressive responsibility for at least on year, preferably two;
Intend to remain in the sector long-term and would like to gain more responsibility.

The Leadership Initiative Participation Requirements:

Serving your mentorship needs: we can match you with someone for up to a year and as little as a few months. Please let us know what kind of mentorship you are seeking.
We suggest that you and your mentor meet at least once monthly for one hour (all meetings can occur in-person or virtually via phone, Skype, etc.)
With your mentor, you will create a list of professional development goals and steps to achieve those goals.
Completion of an evaluation of the mentoring program individually and with your mentor.

I agree that I meet the aforementioned mentee qualifications and that I am able to meet the preceding requirements for participation in The Leadership Initiative. In exchange for my agency's support for my participation in this mentoring program, I agree to continue working for my current employer for at least one year after finishing the program.

Applicant name:

Date:

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