PHCNPG Mentor Program Application
PHCNPG’s Mentoring Program seeks to connect members with the aim to promote growth in specialty practice areas, general career and personal growth. Once you are matched with a mentor/mentee we will notify you both via email. You should be in contact with each other at least once a month and can certainly communicate as often as you like.

The Mentor Program follows the same timeline as the DPG membership year and begins and ends in June each year. At the end of a membership year mentors and mentees will complete a brief survey and mentees only will write a brief summary about their experience. At the end of your term (June) you will have the option to continue your mentor/mentee relationship through the next membership year. Sometimes matches are made in the last few months of the membership year and so it makes sense to continue in the program through the next year. We know that you put a lot of time into building these relationships and will absolutely encourage you to continue on through the next year if both parties are willing! If you have questions or feedback please email Kayla Fitzgerald, Membership Committee Chair at

Qualifications & Responsibilities
Please review the checklist and ensure that you meet the criteria and understand the responsibilities
Profile Information
Full Name & Credentials (if student please list what year)
Your answer
Email and Phone Number
Your answer
Current City and State
Your answer
I am applying to be a:
Select the level of interaction you wish to have
Please share any involvement in nutrition related professional or volunteer organizations
Your answer
Mentees: please briefly discuss what you hope to gain from this experience as well as what area of dietetics you are interested in (if known).
Your answer
Mentors: Please briefly discuss job experience, skills, or areas of expertise.
Your answer
Do you have a request for a potential mentor/mentee?
Your answer
Please use this space to provide any additional information that you think would be helpful to matching you with a mentor/mentee.
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms