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Thank you for your interest in RBMA's Leadership Mentor Program. To be considered, please fill out the application below as thoroughly as possible. The application is due August 3, 2022

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* 1. Full Name:

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* 2. Organization

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* 3. Current Position:

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* 4. Email:

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* 5. Phone (Best number to reach you):

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* 6. Please select your time zone

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* 7. Share a short summary (30-50 words) of the work you perform at your organization:

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* 8. Your educational background [include both formal (degrees) and informal (certificates, proficiencies)]:

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* 9. What interests you in becoming a mentee?

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* 10. What challenges would you like to resolve with your mentor?

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* 11. What are the three ideal characteristics of your mentor?

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* 12. Specific areas of information that would be of most value to you:

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* 13. Select your generation: 

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* 14. What is your race?

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* 15. Please select your age range

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* 16. Select your career stage

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* 17. What is the ideal frequency of mentor/mentee check-in?

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* 18. To avoid pairing you with an individual who is your organization's competitor. Please list the top competitors for you and/or your organization.

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* 19. To match you with a mentor that aligns with your professional and personal goals, please describe the professional strengths and areas for which you seek guidance and mentorship.

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* 20. Where do you see yourself 5-10 years from now?

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