2022-23 GAHE Mentorship Application - Mentee

Thank you for your interest in GAHE's 2022-23 Mentorship Program! The questions below will help us match you with a mentor whom we hope will allow you to reach your goals for the program and vice versa. As such, please answer all of these questions honestly. If you have any comments or concerns, feel free to e-mail the program at gahe.org@gmail.com.

IMPORTANT: Please submit this application by Monday, October 3, so that we can match mentees and mentors before our program launch event this fall.

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* 1. Demographic information:

First and last name

City

State

E-mail address

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* 2. GAHE membership level:

Student member

Member

FACHE

LACHE

Other (please specify)

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* 3. Please indicate your employment status. (Check all that apply.)

Full-time

Part-time

Full-time student

Part-time student

Unemployed

Other (please specify)

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* 4. If employed, what is your current level? If you are currently unemployed, please select “N/A.”

Entry-level

Associate, analyst, etc.

Manager

Director/Executive Director

Vice President/SVP

C-suite

N/A

Other (please specify)

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* 5. What area of healthcare do you work in? If you are currently unemployed, leave this blank.

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* 6. Who is your current employer? If you are currently unemployed, leave this blank.

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* 7. Please indicate your years of relevant experience.

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* 8. If you are a student, what university program are you enrolled in? If you are not a student, leave this blank.

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* 9. Please enter your education history.

Undergraduate degree & school

Graduate degree & school

Doctorate degree & school

Other degree(s) & school(s)

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* 10. Please list professional credentials and certifications:

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* 11. Please list any other professional activities or extracurriculars you would like us to know about.

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* 12. Why are you interested in becoming a mentee?

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* 13. What area(s) of healthcare would you like your mentor to work in or have experience in? (Check all that apply.)

Consulting

Administration

Strategy & operations

Quality

Marketing/PR/Communications

Public health/Policy

Finance

Entrepeneurship

Research/Academia

Insurance payor/Managed care

Contracting/Legal

Human resources

Other (please specify)

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* 14. What, specifically, are your goals for this program?

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* 15. Please rank the following mentor qualities in order of importance (1 being the highest and 6 being the lowest).

Works in a different area of healthcare

Works in a similar area of healthcare

Less experienced

More experienced

Availability

Proximity

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* 16. When are you generally available to meet? (Check all that apply.)

Weekday AM

Weekday PM

Weekends

2022-23 GAHE Mentorship Application - Mentee

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* 1. Demographic information:

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* 2. GAHE membership level:

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* 3. Please indicate your employment status. (Check all that apply.)

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* 4. If employed, what is your current level? If you are currently unemployed, please select “N/A.”

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* 5. What area of healthcare do you work in? If you are currently unemployed, leave this blank.

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* 6. Who is your current employer? If you are currently unemployed, leave this blank.

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* 7. Please indicate your years of relevant experience.

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* 8. If you are a student, what university program are you enrolled in? If you are not a student, leave this blank.

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* 9. Please enter your education history.

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* 10. Please list professional credentials and certifications:

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* 11. Please list any other professional activities or extracurriculars you would like us to know about.

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* 12. Why are you interested in becoming a mentee?

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* 13. What area(s) of healthcare would you like your mentor to work in or have experience in? (Check all that apply.)

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* 14. What, specifically, are your goals for this program?

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* 15. Please rank the following mentor qualities in order of importance (1 being the highest and 6 being the lowest).

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* 16. When are you generally available to meet? (Check all that apply.)

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* 17. What do you perceive to be the roles and responsibilities of a leader?

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* 18. What are the biggest personal and professional challenges you are facing now?

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* 19. What are your ultimate career goals?