Thank you for your willingness to serve as a mentor in the NOSORH Mentoring Program!  Please fill out the information below to allow us to pair you (if needed) with someone seeking assistance in your designated area of expertise.

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. If you have an identified mentee you'd like to work with, please indicate their name and state here.

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* 7. Please select your areas of expertise for which you feel comfortable mentoring. (Select all that apply)

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* 8. 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 Mentor following the guidelines set forth by NOSORH in the Mentor guide. I understand that this application must be resubmitted annually at the request of NOSORH.

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