Mentor Interest Form

For mentee pairing purposes, provide 2-3 sentences describing your experience in the following areas:

The purpose of the Leadership Academy is to enhance the knowledge of a diverse group of promising individuals at an optimal point in their career. The Mentorship program is designed to support participants as they prepare for greater responsibility and increase contributions to their agency, and the substance use prevention, treatment, and recovery support fields.

I understand that my support as a mentor is imperative for the mentee’s successful completion of this eight-month process. I agree to support my mentee by:

1. assuming various roles as a mentor, such as teacher, guide, motivator, coach, counselor, and networker;
2. understanding that successful mentoring relationships are based in mutual respect and building trust where working together means thoughtful communication and setting realistic expectations; and
3. meeting with my mentee once a month (at minimum) virtually or by phone.

I also agree to attend the virtual orientation meeting in February, virtual mentor training in March, and the online mentor group meetings held once a month April through September.