BCSP Professional Mentor Form
Please note: Mentoring will only be recognized if done in addition to regular work activity.

As a mentee/applicant, please submit this form at the time that you send in your application for certification.

The mentor program rewards certificants for encouraging other safety professionals who perform quality work to demonstrate their exceptional skill by obtaining certification. When this mentor form is accepted, BCSP will:

1. Credit the mentor for assisting in the career development of the applicant
2. List the mentor in an honor roll that is published in BCSP’s eNewsletter following the year the mentor form was received

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Please fill in the information of the mentee.
Mentee Salutation
Clear selection
Mentee First Name (legal name)
Mentee Middle Initial(s)
Mentee Last Name (family name, surname)
Certification for Which Mentee Applied
Mentee Email Address
Mentee Company
Mentee Title/Position
Mentee Street Address
Mentee City
Mentee State/Province
Mentee Country
Mentee Zip/Postal Code
Mentee Phone
Mentor Salutation
Clear selection
Mentor First Name
Mentor Last Name
BCSP Credential(s) Currently Held
Mentor Email Address
Mentor Company
Mentor Title/Position
Mentor Street Address
Mentor City
Mentor State/Province
Mentor Zip/Postal Code
Mentor Country
Mentor Phone
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