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2022 RBMA Leadership Mentoring Program - Mentor Application
Thank you for your interest in RBMA's Leadership Mentor Program. Please complete your Mentor Profile by August 3, 2022.
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1.
Name:
(Required.)
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2.
Position:
(Required.)
3.
Email:
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4.
Phone:
(Required.)
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5.
Please select your time zone
(Required.)
Central (CT)
Eastern (ET)
Mountain (MT)
Pacific (PT
Other (please specify)
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6.
Description of your current area, position, and career level
(Required.)
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7.
Past positions/experiences and career development goals that may be key to matching:
(Required.)
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8.
List your leadership skills and competencies
(Required.)
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9.
Your educational background [include both formal (degrees) and informal (certificates, proficiencies)]:
(Required.)
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10.
Would you like to mentor someone who is:
(Required.)
New to Radiology (Radiology culture, structure, and relations)
Building leadership skills
Financial/budgeting acumen
Transitioning to next level of leadership
Career guidance
Technical expertise in the field
Managing a team
Other (please specify)
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11.
Please share two current challenges and how you worked through them?
(Required.)
Challenge 1
Challenge 2
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12.
Select the appropriate category:
(Required.)
Boomers [1946-1964]
Gen Xers [1965-1980]
Millennials [1981-1995]
Gen Z (1996-2012)
Other (please specify)
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13.
What is your race
(Required.)
White or Caucasian
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Another race
Other (please specify)
14.
To avoid pairing you with an individual who is a competitor. Please list the top competitors for you and/or your organization?
15.
What's the deal frequency for mentor/mentee check-in?
Twice a month
Monthly
Every other month
Quarterly
Other (please specify)
16.
What are three leadership resources (i.e., books, articles, etc.) you would recommend to a potential mentee?
Resource 1
Resource 2
Resource 3
Current Progress,
0 of 16 answered