SNA Mentorship Program
Your school email address: _________@cougars.csusm.edu *
Full Name *
Preferred Name
Cohort *
Are you an SNA member? (You do not need to be a member to sign up, but if you are a member you get cord points.) *
Phone Number *
What are your greatest strengths? (e.g. communication, leadership, design, etc.)
What’s the #1 thing you would like to get out of your mentorship (e.g. general career advice & guidance, industry-specific expertise, leadership development, expanding network)
What nursing specialties/departments are you interested in?
Examples: ER, ICU, L&D, Peds, etc.
In 3 years time, you would like to be doing [X] in [Y]:
If you have a mentor in mind place their name and cohort here:
I agree to stay committed with my mentor/mentee, maintain a compromised schedule with my mentor/mentee, and to stay reasonably available. *
I understand that I will abstain from any dishonorable behavior (i.e. dishonesty, plagiarism, etc...). *
I also agree to study to the best of my ability on my own and not to solely depend on my mentor for success in nursing school. I agree to be proactive and to take initiative in regards to my own studies and class work. *
I agree to be a mentor for the cohort that comes in after me, and I can opt-out of the mentorship program at any time by emailing the membership director. *
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