OR APWA Mentorship Application

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Name *

City and State of Residence
*

Email Address
*

Phone Number
*

Preferred way to reach you?
*

Phone

Other:

Are you a member of APWA?
*

Yes

Other:

What is your current or previous level of involvement with APWA-Oregon?

No Experience

Member

Committee Member

Committee Leadership

Board Member

National APWA Committee Member

Clear selection

What is your education level?

High School Diploma

Associates Degree

Bachelor's Degree

Master's Degree

PhD

Clear selection

What was/is your Major?

How many years of experience do you have in your industry? *

Do you mind if your mentoring team member is long-distance?

Yes

Maybe

Clear selection

Are you interested in becoming a Mentor or Mentee with this program? *

Mentor

Mentee

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