The Leadership Initiative: Application

Page One:

Applicant Personal Information

Are you applying to be a mentor or a mentee?

First Name:

Last Name:

Providers' Council Member Agency:

Job Title:

Work Email:

Work Phone:

Pronouns:

If your pronouns are not listed, please select "Not Listed" and email nlamarre@providers.org.

Are you willing to travel to meet with your mentor?

Are you willing to travel to meet with your mentee?

Do you need any reasonable accommodations?

Please note that reasonable accommodation requests must be made by March 11, 2025.

Please indicate any reasonable accommodations here:

Please note that reasonable accommodation requests must be made by March 11, 2025.

I am in this age range:

What languages do you speak?

Please identify your race/ethnicity (check all that apply):

Please specify:

What is your highest level of education?

If you'd like to, describe your degree(s) here:

What is your current gender identity?

Please specify:

What are your hobbies that you'd like to share?

Applicant Career Information

Would you like to send a link to your up-to-date LinkedIn or your current resume?

LinkedIn link:

Current resume upload:

How long have you worked in the human services sector?

How long have you worked at your current agency?

What is your general area of focus within your organization?

Other - Please Describe:

Please briefly describe your current role.

Are there any additional achievements, certificates, credentials or education you would like to include?

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Page Two:

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Essay Questions

What are your career or professional development goals in the human services sector?

What are some skill areas that you would like to learn more about that you could benefit from through mentorship?
Some examples of skill include:
Operations (recruiting, interviewing, contract management, clinical requirements),
Finance (development, grant writing, fundraising, budgeting),
Communications (public relations, oral and written communication, marketing),
Interpersonal Relationships (coaching, team building, conflict management),
Leadership (managing relationships, innovating programs and services, improving processes).

Please describe three skill development areas in which you feel you could provide a strong mentoring relationship for an emerging leader.

Why do you want to be a mentor to an emerging leader?

What do you hope to gain from the Leadership Initiative?

Are there any characteristics of a mentor that you would like, if possible?

Are there any characteristics of a mentee that you would like, if possible?

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Participation Agreement

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Participant Qualifications and Roles for Mentees
Mentees will be Providers' Council member agency employees who:
• Have been working in the sector for at least two years;
• Have been in a position with supervisory responsibilities or demonstrated interest in progressive responsibility for at least one year;
• Intend to remain in the sector long-term and would like to gain more responsibility.

The Leadership Initiative Participation Requirements:

The Providers' Council will attempt to match you with a mentor for a year-long mentorship commitment.
During this year, mentors and mentees should:
• Meet monthly for a minimum of one hour*;
• Work on professional development goals together and brainstorm steps to achieve these goals;
• Complete periodical evaluations of the program.

If at any point you do not wish to continue your mentorship relationship, please reach out to the Providers' Council for assistance.

I agree that I meet the aforementioned mentee qualifications and that I can meet the preceding requirements for participation in The Leadership Initiative.

*This can be in-person or virtually via Zoom or the phone, though we do recommend meeting in-person as is safe to do so.

I agree that I have the above qualifications and will adhere to the participation requirements.

Participant Qualifications and Roles for Mentors
Mentors will be Providers' Council member agency employees who:
• Have been leading staff for at least two years;
• Have a demonstrated history in the nonprofit sector; and
• Can meet the time commitments for the program.

The Leadership Initiative Participation Requirements:

The Providers' Council will attempt to match you with a mentee for a year-long mentorship commitment.
During this year, mentors and mentees should:
• Meet monthly for a minimum of one hour*;
• Work on professional development goals together and brainstorm steps to achieve these goals;
• Complete periodical evaluations of the program; and
• Understand that conversations between mentors and mentees should be considered private.

If at any point you do not wish to continue your mentorship relationship, please reach out to the Providers' Council for assistance.

I agree that I meet the aforementioned mentor qualifications and that I can meet the preceding requirements for participation in The Leadership Initiative.

*This can be in-person or virtually via Zoom or the phone, though we do recommend meeting in-person as is safe to do so.

I agree that I have the above qualifications and will adhere to the participation requirements.