Mentor Interest Form

For protégé pairing purposes, provide 3-5 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 protégé’s successful completion of this eight-month process. I agree to support my protégé 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
3. thoughtful communication and setting realistic expectations;
4. maintaining confidentiality during and after the mentoring period; and
5. meeting with my protégé once a month (at minimum) virtually or by phone.

I also agree to attend the virtual Welcome and Orientation meeting on January 26, 2027; the in-person Mentor Training on March 3-4, 2027 in Denver, Colorado; attend one of the two virtual mentor consultation meetings held on the first and third Thursdays of each month, April through August 2027; and the Leadership Academy Celebration Session on August 31, 2027.