Become an Elite Mentor
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Phone Number
Location
Professional Background
Current Role/Title
Years of Nursing Experience
Choose an Option
Less than 5 years
5-10 years
10-15 years
15+ years
Specialty/Area of Expertise (select all that apply)
Critical Care
Pediatrics
Emergency Room
Oncology
Mental Health
Geriatrics
Other
Other(please specify):
Education Level
Choose an Option
Associate Degree in Nursing (ADN)
Bachelor of Science in Nursing (BSN)
Master of Science in Nursing (MSN)
Doctor of Nursing Practice (DNP)
Other
Other(please specify)
Mentorship Goals
Why do you want to be a mentor?
What do you hope to achieve as a mentor?
What topics or skills are you most passionate about mentoring in? (Select all that apply)
Clinical skills
Communication and teamwork
Stress management and burnout prevention
Career planning and advancement
Leadership development
Other
Other(please specify):
Availability
How many mentees are you willing to mentor at a time?
Choose an Option
1
2
3+
What is your general availability for mentoring?
Weekdays(morning)
Weekdays(afternoon)
Weekdays(evening)
Weekends
Alignment with Further Education
Have you participated in any professional development or continuing education programs?
Yes
No
If yes, please list any certifications, courses, or programs you’ve completed
Are you interested in accessing additional resources or training to enhance your mentorship skills?
Yes
No
Would you be open to sharing your expertise in live sessions, webinars, or resource creation for The Real Nurse Network?
Yes
No
Ways You’d Like to Be Rewarded
What types of rewards would motivate you as a mentor?
Gift cards (e.g., Amazon, Starbucks, etc.)
Access to exclusive professional development courses or certifications
Discounts on nursing-related tools, resources, or subscriptions
Swag or merchandise (e.g., branded items, apparel)
Other
Other(please specify):
Would you be interested in receiving Continuing Education Units (CEUs) for your mentorship activities?
Yes
No
How important is public recognition for your contributions as a mentor?
Choose an Option
Very important
Somewhat important
Not important
Final Details
How did you hear about The Real Nurse Network?
Choose an Option
Social media
Email
Referral from a colleague
Nursing organization
Other
Other(please specify):
Is there anything else you’d like us to know about you?
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