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New York State Public Health Corps (NYSPHC) Mentor Nomination Form

Thank you for your interest in being a Mentor for the NYSPHC . This year, NYS announced the launch of a fellowship program that will not just employ 1,000 public health Fellows across the state, but provide them with additional education, resources, and opportunities to network. Mentors are a critical piece to this experience to share knowledge, provide advice and career planning support, and assist Fellows in navigating their fellowships and the exciting field of public health. Being a Mentor is an important responsibility and we are grateful to our volunteers for dedicating time from their already busy schedules. The role of a NYSPHC Mentor will be a commitment but the Program will offer some flexibility to ensure a positive and fulfilling experience for Fellows and Mentors as we embark in building the next generation of public health professionals in NYS.

Information entered in this form will be shared with selected Local Health Departments (LHDs) for consideration. 

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* 1. Your full name 

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* 2. Please enter your email address.

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* 3. Are you self-nominating or nominating a colleague to be a NYSPHC Mentor?