Mentee Application

Thank you for your interest in the HLNDV Mentoring Program to be a Mentee. Please complete all fields and submit your resume for our committee to match you as quickly as possible. If you have any questions or concerns, please email

* 1. Are you a member in good standing of the American College of Healthcare Executives?

* 2. First and Last Name

* 3. Current Job Title

* 4. Organization Name

* 5. Preferred Phone Number

* 6. Preferred Email Address

* 7. Please select all areas you are interested in receiving guidance from a mentor. (Check all that apply)

  Resume Review and/or Interview Preparation Hospital Management/Acute Care Leadership Long Term Care, Behavioral, Skilled Nursing Facility Leadership Ambulatory or Physician Practice Leadership Healthcare Consulting Managed Care Quality and Process Improvement Nursing, Medical or other Clinical Leadership

* 8. Please select if you have a preference for working with a male or female mentor. (Select one option)

* 9. What level of experience do you look for in a mentor? (Check all that apply)

* 10. What preference do you have for the current role of your mentor? (Check all that apply)

* 11. What characteristics do you look for in a mentor? (Check all that apply)

* 12. Upload your resume (required)

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