CPRS Edmonton's Mentorship Program Protégé Application Form
Please answer all questions the listed below to be considered for the CPRS Edmonton Mentorship Program. 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 a mentor and later shared with your mentor. All successful candidates are notified of their matches by email by the middle of December, and formal matches will 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 *
MM
/
DD
/
YYYY
Which best describes your current gender identity? *
Your answer
CPRS membership number:
Your answer
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