BGWC Mentorship Program: Mentor Application | Winter 2025 Mentorship Program 
About Us: Black Girl White Coat is a 501(c)3 nonprofit organization that provides academic resources, mentorship, and scholarship to Black women pursuing careers in healthcare.

We are launching our Winter 2025 Mentorship Program with plans to have completed mentor - mentee matches by this January depending on availability. 

By signing up, you are agreeing to serving as a mentor for one year (January 2026-December 2026). 

To help us best match you with your future mentee(s), please fill out the following form.

Important things to note:
- Filling out this form does not automatically match you with a mentee. This form indicates your availability as a mentor for the current academic year.
- The email address here will be used to communicate Mentorship Program updates and will be shared with your mentee in the event you are matched.

Eligibility criteria for mentors:
- Must be currently established in your professional practice OR be an active student in professional school (i.e. medical school, dental school, etc.)*
* nurses must have BSN at minimum to be a mentor

Deadline: November 19, 2025 at 11:59 PM EST
Email *
Alternate Email  (please ensure that at least one email is non school / work affiliated) *
As a member of the Black Girl White Coat Mentorship Program, you will be expected to conduct yourself in a respectful and professional manner. Please be sure to review our code of conduct on our website: https://www.blackgirlwhitecoat.org/mentorship
Full Name (First Last) *
Gender *
Required
Ethnicity/Race *
Required
I identify as... *
Required
Where are you located? (City) *
Where are you located? (State) *
Degrees obtained to date. "N/A" if not applicable. *
Required
If you are currently a student, please indicate what degree program you are in and at what stage (ex: 3rd year medical student - DO, 2nd year medical student - MD/PhD, 1st year physical therapy school, etc.) *
Please indicate your mentee preference here (ex: women only, first generation students, students with poor academic history, LGBTQIA+ students, etc.). Type N/A if none. *
How would you like to communicate with your mentee? *
Required

How frequently would you prefer to communicate with your mentee?

 *
How many mentees are you willing to work with? *
 In the event that you are not initially matched with a mentee in January, are you still available to serve as a mentor later on in the year?
 *
How did you hear about the BGWC Mentorship Program? (select all that apply) *
Required
Are you a new or returning Mentor? *
If you answered "returning Mentor": What year(s) did you serve as a BGWC Mentor? 
If you answered "returning Mentor": What motivated you to re-apply as a mentor this cycle? 
If you answered "returning Mentor": please provide feedback that would help improve the program. 
Thank you for being a BGWC Mentor! If there is any additional information that may assist us in matching you with a mentee, please indicate below.
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