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| Billing Contact (if different from above): |
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Internal Sponsor:
Please provide the name and contact of your organizational sponsor for reference purposes.
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| Current Industry:
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| Current Functional Area of Expertise:
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Are you interested on being listined in the peer-to-peer Member Directory to share your expertise with other Members
as a "just-in-time" Peer Mentor?
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| Education & Business Experience:
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Educational, professional, and personal achievements (please include your latest resume).
Highlight key achievements here (awards, education, professional designations, etc.)
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| Resume file to upload: |
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| If you are attaching a resume and feel the following three questions have been adequately
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Overview of your current employer (website, ownership structure, revenues, number of employees)
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Overview of current position (number of direct reports and typical title of immediate reports, key
responsibilities)
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Immediate Supervisor (title) and your reporting level from CEO/President
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Budget level that you are currently responsible for
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Number of years experience in management:
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Number of years experience in senior management:
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| Community Service:
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Please note any community service and/or not-for-profit work that you have been involved with.
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| Other Information:
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Why do you want to be involved in this program as a Mentee?
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Have you participated in a formal mentoring program in the past? If yes, please outline what worked
well and what didn't work as well for you in the process.
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Please describe your personal approach/communication style.
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What kind of Mentor (position, background, industry) would you be most interested in working with?
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How did you hear about us?
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If you selected directory listing, newspaper article, referred by a colleague or other above please
provide details e.g. name of newspaper, name/phone/email of referrer.
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Please be patient when uploading resumes. Click on Submit only once. |
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