Black Nurse Network Mentee Application

Full Name *

First Name

Last Name

Best Mode of Contact *

Phone call

Text

Email

Other

Best time to contact (select all that apply) *

Morning (8am-12pm)

Afternoon (12pm-5pm)

Evening (5pm-9pm)

Weekdays

Weekends

Are you willing to commit to at least one year of being mentored with Black Nurse Network (Aug-May)? *

Yes

No

Are you willing to attend the Mentorship Orientation? *

No

Yes

Are you willing to complete the required monthly check-ins? *

Yes

No

Are you willing to attend all required events? *

Yes

No

Are you a returning BNN mentee?

Yes

No

If so, would you like your same mentor again?

Yes

No