Mentor Application for the New England HIMSS (NEHIMSS) Mentorship Program (2023-24 Program Year)
This is the application form for all NEHIMSS Mentors for the 2023-24 program year.  Note: In order to be considered for the program, applicants must be a current chapter member of NEHIMSS
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Email *
Mentor Name (First & Last) *
Mentor HIMSS Member Number
 *
Mentor Current City and State *
Mentor Phone Number with Area Code *
Mentor LinkedIn Profile Link (if not available enter N/A) *
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