eMentoring Program

Mentoring Sign-Up Form for Mentees (I want to be mentored)

If you are interested in being mentored by another Christian Women in the Marketplace, please complete the following Mentoring Sign-Up form.

First Name:

Last Name:

Address:

City:

State: Zip:

Home Phone: - - Work Ph: - - Ext

Cell Phone: - -

Occupation: How Long? (# years)

Current Position: How Long? (# years)

E-mail:

Education: (select highest level) Age Category:

Have you participated in a mentoring program?

Please describe in general terms what is the area of challenge, opportunity or concern you would like to address with a mentor?

What issues and topics would you like Christian Women in the Marketplace Mentoring program to address?

Are there specific areas which you feel a mentor might assist you to develop in order to become more effective at work?:

Indicate on a scale of 1 to 5 your interest in the following:

(1 = little/no interest to you, 5 = high level of interest)

	Brief Mentoring Encounters - (one hour one-on-one mentoring to discuss timely issues)
	Short-Term Mentoring Relationships (one-on-one situational mentoring over period of 1-3 months)
	Long-Term Mentoring Relationships (one-on-one weekly mentoring over period of 3 - 6 months)
	Quarterly Mentoring Roundtables (experienced women facilitating "Table-Talk" and responding to questions)
	Coffee Time Mentoring (small group social activities where more experienced women are available to discuss topical items over coffee)