Exit Local Health Department Directors of Nursing Mentorship ProgramMentee Application Form Question Title * 1. Full Name (First, Last): Question Title * 2. Email: Question Title * 3. Phone Number: Question Title * 4. County: Commitment: Question Title * 5. Are you committed to meeting with your mentor at least monthly for 6 months? Yes No Question Title * 6. Are you committed to an attitude of learning by maintaining a positive mindset? Yes No Question Title * 7. Are you committed to maintaining professionalism, and communicating with your mentor openly and honestly? Yes No Experience: Question Title * 8. How many years of experience do you have as Director of Nursing in local public health? Question Title * 9. Please list other public health and nursing management experience: Next