The Leadership Initiative: Mentor Application

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Mentor 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.

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

1. Applicant Information

First Name:

Last Name:

Agency:

Job Title:

Work Address:

City:

State:

Zip:

Email:

Work Phone:

Cell Phone:

Preferred pronouns:

How long have you worked in the human service sector?

Please list any certificates or credentials you have received:

Any specific accommodations needed?

How long have you worked at your 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) Please describe three skill development areas in which you feel you could provide a strong mentoring relationship for an emerging leader.

b) Why do you want to be a mentor to an emerging leader?

c) What do you hope to get out of the relationship?

Additional Comments:

Participation Contract

Participant Qualifications and Roles for Mentors

The Leadership Initiative applicants have varying strengths, needs and interests. Our goal is to match mentees with the mentors that best fit their skill needs and interests. The information you provide will help us to best match you with an appropriate mentee.

The Leadership Initiative Participation Requirements:

This is a one-year program.
Mentors must meet at least once monthly with mentee for one hour (meetings may be in-person or virtual, i.e. via phone, skype, etc.).
Mentors are required to completely periodical evaluations during the program.
Mentors must participate at check-ins and discussions as available.

I agree to participate in The Leadership Initiative, including fulfilling the time and program requirements listed above. I have read and understand the program description.

Applicant name:

Date:

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