The Leadership Initiative Application

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Providers' Council
The Leadership Initiative Participant Information

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Mentee Application Form
Please complete this application to apply for The Leadership Initiative. You may save your progress at any time and resume at any time. Note: These applications are processed on a rolling basis. Once you submit ALL of your COMPLETED materials to us we will begin the process of matching you with a Mentor.

Only complete applications will be considered; please included all of the following: 1) Applicant Information; 2) Resume; 3) Essay Questions; 4) Participant Contract; and 5) Supervisor Recommendation Form.

*The Supervisor Recommendation form can be downloaded here. It will need to be filled out by your supervisor and uploaded in Section 5 before your application can be submitted. You can save and resume your application at any time.
Mentor Application Form
Please complete this application to apply as a mentor for The Leadership Initiative. Note: These applications are processed on a rolling basis.

Only complete applications will be considered; please included all of the following: 1) Applicant Information; 2) Resume; 3) Essay Questions; and 4) Participant Contract.

You can save and resume your application at any time.

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1. Applicant Information




















1. Applicant Information














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2. Resume

2. Resume

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3. Essay Questions
Please answer each of the following four questions thoughtfully in not more than 300 words per question.




3. Essay Questions
Please answer each of the following three questions thoughtfully in not more than 300 words per question.



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4. Participation Contract
Participant Qualifications and Roles for Mentees
Mentees will be Providers’ Council member agency employees who:
  • Have been working in the sector for at least two years;
  • Have been with their current agency in a position with supervisory responsibilities or have otherwise demonstrated or shown interest in progressive responsibility for at least one year, preferably two;
  • Intend to remain in the sector long term and would like to gain responsibility or one day lead an agency.
The Leadership Initiative Participation Requirements:
  • Serving your mentorship needs: we can match you with someone for up to a year and as little as a few months. Please let us know what kind of mentorship you seeking.
  • We suggest that you and your mentor meet at least once monthly with for one hour (all meetings can occur in-person or virtually via phone, skype, etc.)
  • With mentor, create a list of professional development goals and steps to achieve those goals.
  • Completion of an evaluation of the mentoring program individually and with your mentor.
I agree that meet the aforementioned mentee qualifications and that I am able to meet the preceding requirements for participation in The Leadership Initiative. In exchange for my agency’s support for my participation in this mentoring program, I agree to continue working for my current employer for at least one year after finishing the program.


4. Participation Contract
Participant Qualifications and Roles for Mentors
  • The Leadership Initiative applicants have varying strengths, needs, and interests. Our goal is to match mentees with the mentors that best fit their skill needs and interests.  The information you provide will help us to best match you with an appropriate mentee. 

The Leadership Initiative Participation Requirements:
  • One year program
  • Meet at least once monthly with mentee for one hour (meetings may be in-person or virtual, i.e. via phone, skype, etc.)
  • Completion of an evaluation during the mentoring program
  • Participation in check-ins and discussions as available
I agree to participate in The Leadership Initiative, including fulfilling the time and program requirements listed above. I have read and understand the program description.


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5. Supervisor Recommendation Form

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Thank you for submitting your application to The Leadership Initiative! We will be in touch shortly to follow up with further information.