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2026-2027 AMPLIFY Mentee Application Form

AMPLIFY Mentee Application Form

Thank you for your interest in the AMPLIFY Mentorship Program at Keiser University, Flagship Campus.

Please complete this application to be considered for participation in the program.

All information submitted will be kept confidential and used solely for program selection, mentor matching, and program planning purposes.

If you have questions about the application or the AMPLIFY program, please contact Dr. R. Audy Johnston:
📧 rijohnston@keiseruniversity.edu

We look forward to learning more about you and helping you take the next step in your professional development journey.
1.Let's start with the basics. Tell us a little about yourself by providing the information below:
2.Which Keiser University location are you enrolled in? Please select one from the dropdown menu.
3.Please upload your Resume 
No file chosen
4.Please upload a Letter of Recommendation from another individual (For example: A direct supervisor, manager, mentor, extra-curricular coach (previous or outside of Keiser University)
No file chosen
5.Please list any certificates, awards, or credentials that you have received.
6.What has been one of the biggest challenges you have faced in your academic, personal, or professional journey? How did you overcome it, and what did you learn from the experience? Please share a specific example.
7.Have you ever participated in another mentoring program? If so, please describe the program(s), explain whether you were a mentor or mentee, and identify three ways you were changed/grew from this experience.
8.What student organizations, campus activities, volunteer opportunities, or community programs have you participated in? What skills, lessons, or experiences did you take away from those opportunities?
9.What are your top 3 career goals?
10.What areas would you like your mentor to help you develop?
11.Please use the space below to provide any additional comments you would like us to consider.
12.Amplify Program Participation Agreement

By signing* below, I agree to:
  • Attend scheduled Amplify meetings.
  • Meet regularly with my assigned mentor.
  • Actively participate in program activities and discussions.
  • Complete any required tasks or assignments.
  • Communicate professionally with my mentor and program coordinators.
*An electronic signature is acceptable.
13.Media Release & Consent

As part of AMPLIFY 2026-2027, photos, videos, and testimonials may be collected during program meetings, events, and activities.

By signing* below, I grant Keiser University permission to use my image, video, and/or testimonial for educational, promotional, marketing, and publicity purposes, including websites, social media, newsletters, presentations, and other university publications.

I understand that:
  • Participation is voluntary.
  • I will not receive compensation for the use of these materials.
  • I waive the right to inspect or approve the final use of these materials.
  • I release Keiser University from any liability related to their authorized use.
*An electronic signature is acceptable.