TANA Ascend Mentee Program Application

TANA Ascend Mentee Program Application

Complete this form to apply as a mentee and share your goals, preferences, and commitment.
Basic Information
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
School
Anticipated Graduation Date

MonthDayYear
Date
AANA Membership Number
Career Goals
Desired Practice Setting
Desired Practice State Post-Graduation
Long-Term Career Goals
Geographic Job Preference
Mentorship Goals
What are your goals for this mentorship, and how can a mentor best support you?
Why do you want a mentor?
Communication Preferences
Preferred Contact Method
Available Days
Available Times
Commitment Agreement
I agree to commit to the program for a minimum of one year.
I agree to complete a follow-up evaluation at the end of the program.
I agree to maintain at least bi-monthly communication with my mentor.
I agree to follow the program expectations outlined in the Mentee Guide.
I understand that I must pay a $25 fee for my application to be processed, and I have indicated how I would like to allocate my payment below.
Thank you for choosing to donate to TANA-PAC! Once you submit the form, you will be redirected a link that goes to our TANA-PAC donation page.