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ANFP Mentee Application
Please complete the information in this form to help us match you with the right mentor.
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1.
Contact information
Name (First, Last)
Member ID
Preferred Email address:
Preferred Phone (Home):
Preferred Phone (Cell):
State:
2.
Please indicate your preferred method of communication:
Email
Text message
Phone call
3.
Please indicate your desired duration of the mentor-mentee relationship:
3 months or less
3-6 months
6-12 months
1+ years
4.
Please select one:
Pre-professional member
Professional member
5.
If you selected Pre-professional member, enter the program you are enrolled in:
6.
If you selected Professional member, enter the number of years as a professional member:
7.
Company/Facility Name
8.
Facility Type:
LTC
Continuum
Acute Care
Correctional
Schools
Other:
9.
Title/Role (if employed):
10.
Tell us about 1-2 goals you hope to accomplish with your mentor:
11.
Is there anything else you wish to share that would assist with a mentor match (additional experience, skills, education, etc.)?
12.
Once you have been assigned a mentor and are notified, mentors will contact mentees within 5-7 business days. As a courtesy, we ask that mentees reply to their mentors within 2 weeks of the initial contact to discuss communication preferences and frequency. Are you able to reply to the initial email/phone/call text within this time frame?
Yes
No
