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Building Exceptional Leaders
Honoring Exceptional Leaders
Supporting Inclusive Communities
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ANCOR
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Leadership Academy Mentor Application
Leadership Academy Mentor Application
Name
(Required)
First
Last
Email
(Required)
Organization
(Required)
Job Title
(Required)
What are the most meaningful skills and attributes you believe you bring to the next generation of I/DD leaders?
(Required)
How many years of experience do you have in a leadership position in any industry?
(Required)
How many years of experience do you have in a leadership position in the field of human services?
(Required)
In which of the following areas would you say you have strong experience or expertise? Please select all that apply.
(Required)
Advocacy & Public Policy
Agency Operations
Executive Leadership
Financial Management
Fundraising & Revenue Development
Human Resources Management
Marketing & Communications
Service Design & Delivery
Technology Management
Other (if your area of expertise is not listed above, please describe here).
Please give an example of your biggest or most meaningful leadership accomplishments.
(Required)
Please describe any formal or informal mentoring experience you have. In describing your experience, please include information about the mentee(s) with whom you worked (e.g., early career professionals, direct support professionals, etc.) and the modes of mentorship in which you engaged.
(Required)
How would you describe your approach to the mentor-mentee relationship?
(Required)
Please use the space below to share any additional information not shared elsewhere in this form.
Leadership Mentor Self Assessment
Please give a rating of a Yes, if you believe this is a strong skill for you, No, if that is not a strong area for you, or Emerging if you continue to work on this area.
Confidence in my values and beliefs about what is needed for the leaders of tomorrow.
(Required)
Yes, I got this.
No, it isn't my strength.
Emerging and getting better.
Great listening skills.
(Required)
Yes, I got this.
No, it isn't my strength.
Emerging and getting better.
Flexibility to change direction as the learner needs.
(Required)
Yes, I got this.
No, it isn't my strength.
Emerging and getting better.
An ability to refrain from being judgmental, while still offering honest, constructive and clear feedback.
(Required)
Yes, I got this.
No, it isn't my strength.
Emerging and getting better.
A willingness to be vulnerable when sharing my own expertise and experiences.
(Required)
Yes, I got this.
No, it isn't my strength.
Emerging and getting better.
Patience in guiding learner(s) through the reflective process.
(Required)
Yes, I got this.
No, it isn't my strength.
Emerging and getting better.
Openness to receiving feedback.
(Required)
Yes, I got this.
No, it isn't my strength.
Emerging and getting better.
The ability to be available to your mentee.
(Required)
Yes, I got this.
No, it isn't my strength.
Emerging and getting better.
