NOBIDAN MIG Mentor Application

NOBIDAN Mentor Application
Name

First NameMiddle NameLast Name
Credentials
Academy Member Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a current NOBIDAN member? If so, what membership category?

StudentActiveRetiredInternationalNot a current NOBIDAN member
Email
example@example.com
Cell Phone Number

Area CodePhone Number
What is your current or last area of practice?
How long have you practiced in your field?
What is your racial/ethnic background? Check all that apply.

Black / African AmericanAmerican Indian / Alaska NativeAsianHispanic / LatinoMiddle Eastern or North AfricanNative Hawaiian / Other Pacific IslanderWhite or CaucasianI prefer not to disclose this informationOther
What is your area of expertise or focus? Check all that apply.

Business/IndustryClinical Nutrition, GeneralCommunication/PublicationCommunity NutritionConsultation and Private PracticeDiabetes CareEducationFood and Nutrition Management/AdministrationFood ServiceGerontologyIntegrative/Functional NutritionLong-Term CareNutrition SupportOncologyPediatricPolicy/AdvocacyRenal NutritionResearchSchool NutritionWeight ManagementWellness/PreventionOther
What type of guidance can you provide? Check all that apply.

Dietetic Internship/RD Exam SupportJob Opportunities/NetworkingResume Guidance/Interviewing SkillsManagement/Leadership SkillsAcademic SupportGeneral Career GuidanceSocial Media/TechnologyCareer/Student Challenges with being a minorityOther
If you had a choice, who are you most comfortable mentoring? Check all that apply.

Student - UndergraduateStudent - GraduateDietetic InternNew RD (less than 5 years in the field)
What is your preferred method of communication? Check all that apply. (Note: While the Mentorship Program Committee will do our best to match mentors and mentees that are in the same geographic area, it is likely that the mentor and mentee will be in different locations and maintain their relationship by other means of communication.)

EmailText MessagePhone CallsVirtual Meeting such as Skype, Google Hangout, etc.
If you prefer a virtual meeting, what platform(s) are you familiar with? Check all that apply.

ZoomSkypeGoogle HangoutGoogle MeetWEBEXGoToMeetingFaceTimeOther
How comfortable are you with technology?

Very ComfortableComfortableNeutralUncomfortableVery Uncomfortable
What do you hope to gain from participating in this mentorship program?

0/200
Is there anything else you would like to share to assist with the matching process?

0/200
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NOBIDAN Mentor Application