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2026 Mentor Program Application
2026 NLC-RISC Mentor Program
**Please complete application only if you have received prior
authorization from your Pool Administrator to participate in the program.**
Applications due no later than October 31, 2025.
*
1.
I would like to participate as a:
(Required.)
Mentor
Mentee
*
2.
Name
(Required.)
*
3.
Pool Name
(Required.)
*
4.
Email address
(Required.)
*
5.
Position/Title
(Required.)
*
6.
Please choose the functional-area that most closely aligns with your position:
(Required.)
IT & Data
Claims
Finance/Accounting
Human Resources
Information Technology
Public Safety Loss Control
Legal
Loss Control
Marketing/Communications/Member Engagement
Pool Administration
Underwriting
Other (please specify)
7.
Check here if you primarily work for a healthcare benefits pool
Yes
No
*
8.
Time in your current position:
(Required.)
*
9.
Number of years in pooling:
(Required.)
*
10.
Please describe your current role and responsibilities. If you have other industry experience, please list that as well.
(Required.)
11.
What do you hope to gain through this mentor program?
12.
Additional comments/questions/etc.
