MHA Mentee Application and Agreement

Before filling out this application to be a mentee, please consider the commitment you will have to make:

Preparation – always have questions or discussion topics you would like to ask your mentor prior to the meeting
Professionalism – communicate with you mentor in a timely manner and always be punctual to your meetings

Name

First Last

Email Address

Telephone number

Preferred method of contact

Phone/text

Mailing address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Undergraduate institution

Degree(s)/major(s)

What country or state are you from originally?

How far are you willing to drive?