CCHL- EHL Executive Mentorship Program
2017-2018 Mentor/Mentee Application
21%
Questions marked with an
*
are required
Exit Survey
First Name:
Last Name:
Employer:
Position:
Email:
Phone Number:
Experience in health care
leadership
(Please check off any that apply to you)
Student
0-4 years experience
5-10 years experience
10+ years experience
If student please indicate Program and Year (e.g. MHA, 1st Year)
*
Applying to be:
Mentor
Mentee
Both
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