2020 NYWICI Mentee Form
First Name *
Your answer
Last Name *
Your answer
Are you a member of NYWICI? *
Email Address *
Your answer
Telephone Number *
Your answer
Name of Employer/School *
Your answer
What field do you work in? Or if you're looking to start in a new field, what field are you interested in? *
Your answer
Number of years working in field (if applicable) *
Your answer
Street Address *
Your answer
City, State, Zip *
Your answer
Are you interested in one-on-one or group mentoring (up to 8 individual mentees with 1 mentor)? *
What are your career interests and areas of expertise? *
Your answer
Why do you want a mentor? (min. of 100 words) *
Your answer
What are you hoping to get out of the NYWICI Mentoring Program? *
Your answer
What can you bring to your prospective mentor and contribute to the program? (min. of 100 words) *
Your answer
Please share anything else you would like us to know about your experience. *
Your answer
Checking this box indicates that you have acknowledged and accepted the 2020 Mentee Guidelines and Agreement which can be found on the website. *
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