Mentee Application
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Step
1
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Personal Information:
Name
*
First
Last
Layout
Email
*
Phone
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
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Educational Background:
Nursing School/University:
*
Layout
Current Semester
*
Season
Spring
Summer
Fall
Winter
Year
*
Year
2023
2022
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2018
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2016
2015
2014
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2012
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Layout
Expected Graduation Date
*
Season
Spring
Summer
Fall
Winter
Date
*
MM
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DD
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YYYY
2024
2023
2022
2021
2020
2019
2018
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2014
2013
2012
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Goals and Expectations:
What are your goals for participating in the mentorship program? (200 words)
*
What specific areas do you need help with in your nursing studies? (e.g., exam preparation, clinical skills)
*
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Availability:
Layout
Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Time
*
Prefered Meeting Time
*
Morning
Morning
Afternoons
Nights
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Commitment:
Can you commit to at least 2 hours per week for mentorship sessions?
*
Yes
No
Upload Transcript or Proof of Enrollment:
*
Click or drag a file to this area to upload.
Submit
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