Make your impact. Pave your path.

What are your personal interests and hobbies outside of work?

(This is so we can match mentors and mentees with similar interests outside of the office!)

First Name

Last Name

With which of the following do you identify? *

Male

Female

Non-Binary

Let me type..

Do you identify as any of these groups? *

Please help us to get to know you so we can understand the reach of ELF, assess our efforts on inclusion, and improve upon our efforts next time

Indigenous

Black

Person of Colour

Not Applicable

What would you like to gain from this program? *

Learn about a different area of healthcare

Learn about transitions into healthcare

Learn about transitions within healthcare

Learn about career management and growth

Learn about future trends impacting health careers

What is your preferred method of meeting? *

In person

Video chat/telephone

A mix of both

How often would you be able to connect with your mentor? *

Once every two weeks

Once per month

Once every two months

As needed or flexible

Other

What stage of their career would you want your mentor to be in? *

5-9 years

10-20 years

20+ years

What stage of your career are you in? *

<2 years

2-4 years

5-9 years

10-20 years

How do you best receive feedback? *

Softer tone

Candid

Depends on my relationship with my mentor

Have you worked outside of healthcare? *

Yes

No

Would you like your mentor to have worked outside of healthcare? *

Yes

No

Is your ideal mentor… *

In health economics

In health informatics/technology

In health policy

In research

In healthcare administration

A clinician

Outside healthcare

In health consulting

In home and community care services

Are you... *

In health economics

In health informatics/technology

In health policy

In research

In healthcare administration

A clinician

Outside healthcare

In health consulting

In home and community care services

ELF may use materials from the mentorship program for marketing materials. Do you consent? *

Yes

Would you be willing or would you want to connect with other members in the mentorship cohort outside of your 1-1 connection? *

Yes

No

Have you ever attended an ELF event before? *

Yes

No

As part of our partnership with HIMSS, accepted applicants will need to become a member of the organization (global or chapter level). If you are accepted into the program, you acknowledge that you will need to be a member of HIMSS to be part of the mentorship program

Yes

Name *

First Name

Last Name

With which of the following do you identify? *

Male

Female

Non-Binary

Let me type..

Do you identify as any of these groups? *

Please help us to get to know you so we can show the reach of ELF, assess our efforts on inclusion, and improve upon our efforts next time

Indigenous

Black

Person of Colour

Not Applicable

What would you like to contribute to this program? *

Advice on future trends impacting health careers

Advice on career management and growth

Advice on different areas of healthcare

Advice on transitions into healthcare

Advice on transitions within healthcare

What is your preferred method of meeting? *

In Person

Video chat/Telephone

A mix of both

How often would you be able to connect with your mentee? *

Once every two weeks

Once per month

Once every two months

What stage of your career are you in?

5-9 years

10-20 years

20+ years

What stage of their career do you want your mentee to be in? *

<2 years

2-4 years

5-9 years

10-20 years

How do you give feedback? *

Softer tone

Candid

Depends on what the mentee reacts to best

Have you worked outside of healthcare? *

Yes

No

Is your ideal mentee… *

In health economics

In health informatics/technology

In health policy

In research

In healthcare administration

A clinician

Outside healthcare

In health consulting

In home and community care services

Are you... *

In health economics

In health informatics/technology

In health policy

In research

In healthcare administration

A clinician

Outside healthcare

In health consulting

In home and community care services

ELF may use materials from the mentorship program for marketing materials. Do you consent? *

Yes

Would you be willing or would you connect with other members in the mentorship cohort outside of your 1-1 connection? *

Yes

No

Have you attended an ELF event before? *

Yes

No