2020 NYWICI Mentor Form
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First Name *
Last Name *
Email Address *
Telephone Number *
Name of Employer/School *
Number of Years Working in Your Field (if applicable) *
Street Address *
City, State, Zip *
Are you interested in one-on-one or group mentoring (up to 8 individual mentees with 1 mentor)? *
What are your career interests and areas of expertise? *
What are you hoping to get out of the NYWICI Mentoring Program? *
What can you bring to your prospective mentee(s) and contribute to the program? *
Have you ever served as a mentor? *
Please share anything else you would like us to know about your professional experience. *
Checking this box indicates that you have acknowledged and accepted the 2020 Mentor Guidelines and Agreement which can be found on the website. *
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