CPRS Edmonton's Mentorship Program Mentor Application Form
Please answer all questions. Incomplete applications will not be considered. The deadline for applications is December 4, 2017.

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 December, and the program will formally commence in January 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 *
Which best describes your current gender identity? *
Your answer
CPRS membership number:
Your answer
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