2024 WCN Diverse Nurse Faculty Mentorship Program Mentor Training Institute Application

The Washington Center for Nursing (WCN) is recruiting nursing leaders in academic, practice and/or community service as mentors for diverse faculty teaching in Washington colleges or universities. The purpose of this program is to provide career support to ensure success of our diverse faculty mentees in their respective roles.

Thank you for your interest in applying to attend the WCN Mentor Training Institute and serve as a mentor in our Diverse Nurse Faculty Mentorship Program beginning January 25, 2024. If accepted, mentors will agree to meet with their mentees at least once a month either in person or remotely over a one-year period.

Mentors must also commit to:

1. Attend a two-day Mentor Training Institute to prepare for this role and important responsibilities. The dates for this event are from (8 a.m.-4:30 p.m.) Thursday, January 25, and Friday, January 26, 2024 (Professional Development Contact Hours available.)

2. Complete the Intercultural Development Inventory (IDI) assessment prior to the Mentor Training Institute.

3. Participate in one-hour group coaching sessions every other month for 6 months via virtual conference from February through July 2024.

Thank you so much for your commitment to supporting the success of a diverse faculty in Washington state. Please complete the following questions and submit by clicking the DONE button.

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* 1. Name (First & Last):

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* 2. What is your self-identified race and ethnicity?

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* 3. What is your self-identified gender?

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* 4. Address:

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* 5. Phone Number:

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* 6. Email Address:

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* 7. Place of Current Employment (or former if retired):

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* 8. What is/was your leadership role?

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* 9. How many years have your served in this type of leadership role?

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* 10. What do you hope to gain from your participation in this mentorship program?

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* 11. What are strengths that you can bring to this program including any prior experiences as a mentee or mentor?

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* 12. What specific topics are your comfortable working with mentees. Please check all that apply.

Teaching-Didactic Techniques

Teaching-Clinical Teaching Techniques

Teaching-Mentoring Students

Teaching-Serving on Thesis and Dissertation Committees

Leadership-How to know when you are ready to take on chairing a committee or officer in an organization.

Leadership-How to know when you are ready to take on an administrative position such as Program Chair or Dean.

Scholarship-Designing a Research Program.

Scholarship-Writing Publications.

Service-What kinds of faculty service help with professional advancement.

Preparing for Promotion and Tenure.

Balancing an Academic Life

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* 13. Do you have any preferences for working with a mentee from any specific race, ethnic, or underrepresented groups?

Yes

If yes, please provide additional information.

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* 14. Do you have any additional comments that you would like to share related to how to best match you with a mentee?

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* 15. Typing your name in the box below serves as an electronic signature and agreement to the requirements and expectations if selected to serve as one of our mentors.

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* 16. Please attach an up-to-date copy of your CV or Resume with your submission.

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