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2015 Mentor Circles Application
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Name *
Email *
Phone Number *
What is your current occupation? *
Do you want to stay in your 2014 Mentoring Group?
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If so, please list the members of your group.
Are there AWIS members you would like to be grouped with?  Please list their name (s) here.
If you would like to be in a group based on location, please choose from the following
If you would like to be in a group based on interest, please choose from the following
Would you like to be a group leader? *
Are you able to commit to meeting with your mentoring group every 4-6 weeks?
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Why are you interested in the Mentoring Circles Program?
What do you hope to gain from the Mentoring Circles Program?
Do you have a specific concern/interest you would like mentoring assistance?
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