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Mentor Interest Form
Please provide the following information if you are interested in offering a rich shadowing/mentoring experience (please read the overview provided on the website).
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* Indicates required question
Employer Name
*
Your answer
Employer Address (including zip code)
*
Your answer
Brief description of work
*
Your answer
Number of employees (estimate if necessary)
*
Your answer
Contact name
*
Your answer
Contact title
*
Your answer
Contact phone number
*
Your answer
Contact email
*
Your answer
Describe the type of work you see a student doing
*
Your answer
When you would be able to host a student (for 10 days) - check all that apply
*
Summer
Fall
Winter
Spring
Required
Indicate which arrangement works best
*
10 consecutive work days (over 2 weeks)
One day a week for 10 weeks
Other:
How many students would be willing to host?
*
1
2
3
Other:
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