Apply to become a Mentee

Each mentee applicant must have written approval from their supervisor or organization. Please be ready to submit a letter of recommendation from your supervisor when submitting this application. Organizations that sponsor mentees who are accepted into the program will be asked to make a charitable donation of $2,500 to Valleywise Health Foundation.

Full Name *

I prefer to be called *

Phone Number *

Email *

Social media handles (LinkedIn, Twitter, Instagram, etc.)

Education *

Company/Organization *

Job Title and Brief Description *

Previous Occupation/Career(s) *

Family (spouse/partner, children, pets)

Favorite Quote *

Favorite Book or Movie *

One goal for this upcoming year is... *

What does diversity mean to you? *

How have you been involved in community service in the past? Which community groups/issues would you like to learn more about? *

Who nominated you as a mentee? *

Nominator's Contact Information *

Name of Nominator's Organization *

Nominator's Letter of Recommendation *

Click or drag a file to this area to upload.

Additional Materials (resume, cover letter, portfolio, etc.)

Click or drag files to this area to upload. You can upload up to 3 files.

High resolution Headshot *

Click or drag files to this area to upload. You can upload up to 3 files.