Boston Young Healthcare Professionals · Mentee Application 2018-19

Contact Information

Name

*

Prefix

First Name

Last Name

Suffix

Current Job Title

*

Current Company/Organization

*

Company/Organization Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Preferred Email

*

Preferred Phone Number

*

Check one:

*

Home

Work

Cell

Are you a student?

*

Yes

No

If yes, please list the name of your school and the degree you are seeking:

Are you a current member of BYHP?

*

Mentees must be active BYHP members

Yes

No

Career Data

Please attach a current copy of your resume or CV.

*

If you selected "Other," please specify:

How many years of professional experience do you have in your current field?

*

Do you have past experience in other sectors? If yes, please specify which sectors and number of years.

*

Do you have an advanced degree(s)? If yes, please specify:

*

Mentees should either be students or early to mid-career professionals. (Up to 10 years experience).

Other Questions

Describe your ideal mentor. What sector of healthcare does this person work in? Describe any personal qualities that are important to you in a mentoring relationship.

*

What are three things you want to get out of this program?

*

What do you have to contribute to a mentor relationship?

*

Have you been a mentee or a mentor before?

*

Yes

No

Have you ever been a mentee or mentor before? If so, describe what you enjoyed about your experience(s) and what you found to be challenging.

*

Mentee Agreement

*

I agree to fully participate in the BYHP Mentor Program. If selected to be a mentee, I agree to meet with my mentor in-person at least once every two months over the next six months at a time and place that is mutually convenient. I agree to represent BYHP professionally at all times. I understand that the purpose of the Program is to encourage professional development and to build mutually beneficial relationships between established mid-to-senior level professionals and early-to-mid-career professionals or graduate students. I also understand that mentors are under no obligation to offer jobs to mentee(s) and I will not ask my mentor to help me get a job. If a job offer occurs as a natural outcome of the relationship, I will be gracious and appreciative and follow up with a thank you card to my mentor. If I need to reschedule a meeting with my mentor, I will give him/her at least a 48 hour courtesy notice.

I agree to the Mentee Agreement

Electronic Signature

*

Type name.