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Mentor Sign-Up Form
The purpose of this form is to collect necessary information for the mentor-mentee match-up process.Thank you again for participating in our program!
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* Indicates required question
Are you currently a member of NTXISSA? (You must be a member of good-standing to be a mentor?)
*
Yes
No
Name
*
Your answer
Phone Number
*
Your answer
Email
*
Your answer
Preferred communication method?
*
Phone
Email
Level of education?
*
Trade School/Certificate Programs
Associate’s Degree
Bachelor’s Degree
Master’s Degree
PhD
Are you employed?
*
Yes
No
Do you have any certifications? If so indicate them below
*
CISSP
CISM
CISA
Security+
CEH
GSEC
CRISC
Other:
Required
How many mentees would you be able to handle? (max numbers of mentees per mentor is 5, anything more than that must be approved by James Grisham)
*
1
2
3
4
5
Can you dedicate at least one hour every two weeks per mentee?
*
Yes
No
NTX requires a background check for each mentor, are you comfortable sharing private info for this purpose? If you have any questions about this you can reach out to our director James Grisham
*
Yes
No
What are your strengths?
*
good time management
effective communication
working in a team
working alone/self management
organized
public speaking
patience
working through a conflict
not afraid to say, "I don't know."
managing stress
Other:
Required
Do you have a LinkedIn account? If so please provide a link to your profile
*
Your answer
Questions or concerns about the program?
*
Your answer
Do you think cereal is soup?
*
Yes
No
Maybe
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