CPRS Edmonton's Mentorship Program (Mentor Application Form)
Please answer all questions. Incomplete applications will not be considered. The deadline for applications is October 20, 2018.

Upon submitting your application, you will receive a confirmation email within one week. Should you not hear from us within this period, please contact both CPRS Edmonton's Mentorship and Education Co-Chairs, Marjorie Henderson at marjorie.c.henderson@gmail.com and Mikiko Van Horn at mikikovhorn@gmail.com.

The information collected in this form will be used to match you with your protégé. All successful matches will be notified via email by the middle of November 2018, and the program will formally commence in December 2018.

If you have any questions about the program please kindly email mentorship@cprsedmonton.ca.

Email address *
Name *
First and last name
Your answer
Birthday *
MM
/
DD
/
YYYY
Which best describes your current gender identity? *
Your answer
CPRS membership number:
Your answer
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