Mentee application

First name *

Your first name, e.g., Willow.

Last name *

Your last name, e.g., Rosenberg.

Company

Company you work for.

Job Title *

Company Address

Email *

Your email address.

Phone Number *

Mobile Phone Number

What program year are you applying for? *

eg: 2017

Which program are you applying for? *

Why do you want to be a mentee? *

When would you prefer to meet with your mentor? *

Morning

Mid-Day

Evenings

Weekends

How would you prefer to meet with your mentor? *

In person

Phone

Online (e.g., Skype)

Briefly describe your current position *

What are your career goals? *

List 3 goals you want to achieve in the mentoring program *

Select your professional strengths *

If "Other", please explain

Select the top 3 areas where you are seeking improvement: *

If "Other" please explain:

Identify your technical expertise *

If "Other", please explain

List your professional and/or personal accomplishments in the past year *

List your current professional projects *

Would you like to be contacted about our scholarship process? *

Yes

No

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