COHORT #3 MENTEE NOMINATION FORM - SMI Advancing Women Leaders Program

Nomination Form
Deadline: May 31, 2024

PLEASE NOTE:

Mentees should be DIRECTOR level and play a strategic role in your organization. Mentees should be on a path to growth.

As a Sponsor it is important that you commit to participate in this 12-month program along with Mentee you wish to nominate.

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* 1. Are you from a(n):

Provider (hospital, hospital system, IDN, academic, medical center)

Industry Partner (supplier, manufacturer, distributor, software/technology company,)

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* 2. Provide your contact information

Name

Title

Organization

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* 3. Tell us why you wish to be a Sponsor for this individual.

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* 4. What do you want to work on together with your Nominee to further their career path at your organization?

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* 5. As a potential Sponsor in the AWL program, please indicate if you are able able to commit to the following:

Attend in-person workshop for the entire afternoon on Wednesday, October 24 in Austin after the Fall 2024 Forum

Help create a personal development plan in partnership with my Mentee and the Mentor

Attend check-In meetings with Mentor and Mentee

Attend virtual peer-to-peer learning sessions throughout the 12-month program

Allow my Mentee to attend both the SMI Fall 2024 Forum and SMI Spring 2025 Forums in-person

Comments:

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* 6. Provide the contact information for the person you are nominating (Nominee):

Name

Title

Organization

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* 7. How long has this Nominee worked for your organization?

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* 8. Tell us the role this Nominee holds at your organization:

Directly involved in supply chain functions

Directly involved in providing customer service/customer care

Other (please specify)

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* 9. Who does this Nominee currently report to:

This Nominee reports to you

This Nominee reports to someone else (Please explain below)

The Nominee reports to:

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* 10. Explain why this Nominee should be considered for this program:

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* 11. What are the top 3 characteristics this nominee possesses:

	1st Characteristic	2nd Characteristic	3rd Characteristic
Drive to Succeed	Drive to Succeed 1st Characteristic	Drive to Succeed 2nd Characteristic	Drive to Succeed 3rd Characteristic
Time Management Skills	Time Management Skills 1st Characteristic	Time Management Skills 2nd Characteristic	Time Management Skills 3rd Characteristic
Positive Attitude	Positive Attitude 1st Characteristic	Positive Attitude 2nd Characteristic	Positive Attitude 3rd Characteristic
Self Motivated	Self Motivated 1st Characteristic	Self Motivated 2nd Characteristic	Self Motivated 3rd Characteristic
Willingness to Learn	Willingness to Learn 1st Characteristic	Willingness to Learn 2nd Characteristic	Willingness to Learn 3rd Characteristic
Honesty/Integrity	Honesty/Integrity 1st Characteristic	Honesty/Integrity 2nd Characteristic	Honesty/Integrity 3rd Characteristic
Clear Verbal Communication	Clear Verbal Communication 1st Characteristic	Clear Verbal Communication 2nd Characteristic	Clear Verbal Communication 3rd Characteristic

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* 12. What areas of personal growth does your Nominee need to progress in their career journey?

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* 13. Share any additional pertinent details you would like the the AWL Steering Committee to know about this individual and/or your commitment to this program:

Thank you for submitting this nomination.

100% of survey complete.

COHORT #3 MENTEE NOMINATION FORM - SMI Advancing Women Leaders Program

Nomination FormDeadline: May 31, 2024

Question Title

* 1. Are you from a(n):

Question Title

* 2. Provide your contact information

Question Title

* 3. Tell us why you wish to be a Sponsor for this individual.

Question Title

* 4. What do you want to work on together with your Nominee to further their career path at your organization?

Question Title

* 5. As a potential Sponsor in the AWL program, please indicate if you are able able to commit to the following:

Question Title

* 6. Provide the contact information for the person you are nominating (Nominee):

Question Title

* 7. How long has this Nominee worked for your organization?

Question Title

* 8. Tell us the role this Nominee holds at your organization:

Question Title

* 9. Who does this Nominee currently report to:

Question Title

* 10. Explain why this Nominee should be considered for this program:

Question Title

* 11. What are the top 3 characteristics this nominee possesses:

Question Title

* 12. What areas of personal growth does your Nominee need to progress in their career journey?

Question Title

* 13. Share any additional pertinent details you would like the the AWL Steering Committee to know about this individual and/or your commitment to this program:

Nomination Form
Deadline: May 31, 2024