Philippine Nurses Assocation of America: Patnubay sa Pagtatagumpay Program (P3)
Mentor Application

Mentor Application

Qualifications of Mentors

A candidate for mentor must satisfy 1, 2, and 3 mandatory criteria and at least one of the remaining criteria:

1. Hold a current, active, unrestricted RN License in any state, US territory, or another country.

2. Bachelor, Master's, or doctoral degree in nursing or related fields.

3. PNAA Membership is active and is in good standing
4. Expertise in clinical practice, education, administration, and research in nursing and health care in a local, regional, national, or global context.
5. Expertise in nursing research and application, dissemination, including publications.
6. Implemented and mentored others on culturally congruent and competent care through education, research, practice, and administration.
7. Led in disseminating and implementing concepts, models, theories, and research in nursing practice, administration, education, and research.
8. Published or presented in nursing, healthcare, technology, and innovations to local, regional, national, and global audiences.
9. Contributed to local, regional, national, and international health policy development.

Question Title

* 1. Applicant's Demographic Questions

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. Highest Level of Education

Bachelor Degree

Marster's Degree

Doctoral Degree

Post-Doctoral Fellowship

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* 3. Current Role (Level of Responsibility)

Clinical Staff/ Advanced Nurse Practitioner

Consultant

Coordinator/ Specialist

Dean/ Faculty

Director/ Manager

Executive/ Vice President

Other

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* 4. Organizational Type

Acute Care

Community/ Professional Association

Military/ VA/ Government

Long term Care/ Rehabilitation

Post-Acute Services

School/Academia

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* 5. How long have you been part of a mentoring relationship (as a mentor)

I've never been

Less than 6 months

6 months- 1 year

1 year- 2 years

more than 2 years

3-5 years

more than 5 years

Question Title

* 6. As a mentor, what is/are your main goal(s)in participating in the PNAA Patnubay sa Pagtagumpay Program (P3)?

Advice on independent work habits (work-life balance)

Advice on team skills

Career Guidance/ Moving to Another Ladder (Next Level)

Carrer Guidance /Moving to Another Specialty/ Field)

Certification

Networking Experience

Technical Skills

Other

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* 7. What certification would you like to pursue next year?

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* 8. What learning needs/professional gaps/educational topics would you like to be addressed throughout the mentorship program? List your three priorities.

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* 9. Please upload your current Curriculum Vitae or your Resume here:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 10. Upload Your Head Photo Here

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Philippine Nurses Assocation of America: Patnubay sa Pagtatagumpay Program (P3)Mentor Application

Mentor Application

Question Title

* 1. Applicant's Demographic Questions

Question Title

* 2. Highest Level of Education

Question Title

* 3. Current Role (Level of Responsibility)

Question Title

* 4. Organizational Type

Question Title

* 5. How long have you been part of a mentoring relationship (as a mentor)

Question Title

* 6. As a mentor, what is/are your main goal(s)in participating in the PNAA Patnubay sa Pagtagumpay Program (P3)?

Question Title

* 7. What certification would you like to pursue next year?

Question Title

* 8. What learning needs/professional gaps/educational topics would you like to be addressed throughout the mentorship program? List your three priorities.

Question Title

* 9. Please upload your current Curriculum Vitae or your Resume here:

Question Title

* 10. Upload Your Head Photo Here

Philippine Nurses Assocation of America: Patnubay sa Pagtatagumpay Program (P3)
Mentor Application