Application for Mentors

The formal mentor-mentee relationship is designed to strengthen professional foundations by promoting knowledge applications and professional growth. This relationship requires engaged participation and commitment by both parties. By completing this application for enrollment in the Advanced Practice Provider Mentorship Program, you are agreeing to a commitment duration of 1 year. Meetings between mentors and mentees should occur at a minimum of quarterly (at least 4 times) during the year.

Personal Information

Years as a provider:

Years as a provider at UC Davis Health:

Population:

Practice Environment:

Mentorship track

Select the areas you are interested in providing mentorship. There is also a place to add in any areas in which you are interested in providing mentorship that are not reflected in the grid. A copy of the grid is included at the bottom of the page.

Academic

Clinical

Leadership

Education

Research

Reverse Mentoring

Other:

Are you open to mentoring in group setting? For example, 2-4 mentees with similar mentorship needs. This would include meeting together as a group for a specific, shared mentorship request such as public speaking skills or pursuing a specific academic track.

Yes

Comments related to this question:

Help us get to know you better:

What strengths do you bring to the mentor role?

Detail past experience with mentorship, as a mentor or as a mentee, if any.

What is motivating you to become a mentor?

What else would like us to consider when matching you with a mentee?

Track	Brief Description of Areas of Mentorship	Possible Mentor Pairings
Academic	APPs interested in: Pursuing advanced degrees or certificates including but not limited to DNP, Ph.D, advanced practice post master's, RNFA Pursuing faculty roles at academic institutions	APP familiar with the process of pursuance of advanced education including exploration of various pathways, application process and mentee support while established in a program APP currently or previously serving as adjunct/associate/volunteer faculty at an academic institution
Clinical	APPs interested in: Exploring opportunities for evolution in clinical practice including strengthening of knowledge base or clinical skills and adding to clinical toolbox, or transition to new practice setting or specialty	APP established in their clinical career who possesses a wide breadth of clinical knowledge and is interested in helping the mentee identify additional opportunities for clinical growth
Leadership	APPs interested in: Exploring opportunities for APP leadership roles at UC Davis Health and in the community	APP currently or previously serving in a leadership position within the health system or in a professional healthcare organization
Education	APPs interested in: Improving presentation proficiency including development of content, use of standardized content and public speaking skills	APP familiar with spectrum of education preparation and delivery including creation of unique content, project development and well versed in presentation skills. Settings for education include unit-based projects, community, professional meetings and academic settings
Research	APPs interested in: Development of skills of a Nurse Scientist including leading or participating in research studies, policy writing/review and evidence-based practice at UC Davis Health Mentorship throughout the publishing process Developing and conducting quality improvement projects and/or writing of case reports	APP familiar with development of advanced practice research, quality improvement projects or the stages of preparing and submitting a body of work for publication or presentation APP familiar with the analysis and implementation of evidence-based practice
Reverse Mentoring	Senior/experienced/older APPs interested in: Receiving mentorship from a more junior or less experienced employee	APPs (junior and senior) interested in the reversal of traditional roles of mentor and mentee A junior, younger or less experienced APP that can share their expertise in areas such as use of technology or digital media topics. May also offer unique generational insight into content related to diversity, inclusion for project or education planning
Other Areas of Mentoring Not Listed		Please write in an area of mentoring you are requesting to either receive or provide that you do not see reflected in this list. The APP Mentoring Committee will consider each request and potential mentor individually