Thank you for your interest as a mentee in the NOSORH Mentoring Program!  Please fill out the information below to provide more detail about your goals.

Program Overview: The NOSORH Mentoring Program is an opportunity for new SORH Directors to participate in a mentoring experience with veteran SORH leaders from across the country, based upon the Jim Bernstein mentoring philosophy.
 
The experience is intended to last approximately six (6) months, engaging the mentor and mentee in identifying and achieving professional development goals. As a component of this, mentees are required to attend the New SORH Orientation with FORHP and attend a NOSORH 101 webinar with NOSORH staff. Additional opportunities exist to enhance the experience, including the use of the NOSORH Educational Exchange Scholarship to coordinate a face-to-face site visit between the mentor and mentee.
 
Mentors will work collaboratively with their assigned mentee to acclimate them to the SORH Proficiencies model, identify strategic goals for the mentoring experience, and offer support as appropriate.


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* 1. Name

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* 2. Job Title

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* 3. State:

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* 4. E-mail address:

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* 5. Phone number:

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* 6. How long have you been in your current position (years, months)?

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* 7. If you have a mentor already selected, please indicate their name and state here.

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* 8. How do you envision the NOSORH mentoring program impacting your performance as a key SORH staff member?

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* 9. Please select the area(s) about which you would like to learn more:  (To indicate your selection please check next to your areas of interest.  You can also type in an explanation).

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* 10. By checking this box, I indicate that I have read and understand the conditions of participation in the NOSORH mentoring program. I agree to participate as a Mentee following the guidelines set forth by NOSORH in the Mentee guide.

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