ISAWWA Mentoring Program - Application to be a MENTOR

Mentor Application

Hello! We are so excited that you are interested in becoming a ISAWWA Mentor! Please fill out this application so that we can learn more about you and match you with a mentee.

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1. Name (Required.)

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2. Email address (Required.)

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3. Mailing Address (Required.)

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4. City, State and Zip (Required.)

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5. Company (Required.)

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6. Phone number (cell) (Required.)

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7. Phone number (office) (Required.)

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8. Current job title: (Required.)

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9. College degree earned

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10. Certification(s) license(s) held:

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11. You feel comfortable providing (select one or both) (Required.)

traditional one-on-one mentoring

coaching

Other (please specify)

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12. How many mentees would you like to work with at one time?

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13. You feel comfortable mentoring (choose one or both)

males

females

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14. Please describe your career path. Think of the major jobs you have held and list the titles in sequential order. This will give mentees an idea if you have followed a similar career path to the one they are on. For example: lab tech, child health consultant, chemist, lab supervisor.

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15. Years you have worked in the water industry

0-5

6-15

15-25

26 or more

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16. Describe what you do on a day-to-day basis at work.

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17. Do you have any previous experience mentoring? If yes please explain.

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18. What specific qualities, skills, or other attributes do you value in yourself and that you feel will be beneficial to a mentee?

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19. Describe what you consider to be your strongest technical and professional competencies, for example, pump maintenance, networking skills, career planning, water quality, etc.:

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20. How much time would you like to devote to mentoring? (select one)

1 hour per week

3 hours per month

2 hours per month

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21. How far are you willing to travel to meet with your mentee? (select one)

online or phone only

30 minutes

1 hour

2 hours

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22. What do you think will be the most challenging aspect of being a mentor?

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23. What do you hope to gain by being a mentor?

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24. What do you like to do when you are not at work?

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25. What are your expectations for this mentoring experience?

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26. Is it okay for the ISAWWA Mentoring Program administration to communicate with you via email?

Yes

If no, please explain

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* 1. Name (Required.)

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* 2. Email address (Required.)

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* 3. Mailing Address (Required.)

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* 4. City, State and Zip (Required.)

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* 5. Company (Required.)

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* 6. Phone number (cell) (Required.)

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* 7. Phone number (office) (Required.)

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* 8. Current job title: (Required.)

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* 9. College degree earned

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* 10. Certification(s) license(s) held:

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* 11. You feel comfortable providing (select one or both) (Required.)

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* 12. How many mentees would you like to work with at one time?

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* 13. You feel comfortable mentoring (choose one or both)

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* 14. Please describe your career path. Think of the major jobs you have held and list the titles in sequential order. This will give mentees an idea if you have followed a similar career path to the one they are on. For example: lab tech, child health consultant, chemist, lab supervisor.

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* 15. Years you have worked in the water industry

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* 16. Describe what you do on a day-to-day basis at work.

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* 17. Do you have any previous experience mentoring? If yes please explain.

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* 18. What specific qualities, skills, or other attributes do you value in yourself and that you feel will be beneficial to a mentee?

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* 19. Describe what you consider to be your strongest technical and professional competencies, for example, pump maintenance, networking skills, career planning, water quality, etc.:

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* 20. How much time would you like to devote to mentoring? (select one)

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* 21. How far are you willing to travel to meet with your mentee? (select one)

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* 22. What do you think will be the most challenging aspect of being a mentor?

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* 23. What do you hope to gain by being a mentor?

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* 24. What do you like to do when you are not at work?

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* 25. What are your expectations for this mentoring experience?

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* 26. Is it okay for the ISAWWA Mentoring Program administration to communicate with you via email?

1. Name (Required.)

2. Email address (Required.)

3. Mailing Address (Required.)

4. City, State and Zip (Required.)

5. Company (Required.)

6. Phone number (cell) (Required.)

7. Phone number (office) (Required.)

8. Current job title: (Required.)

9. College degree earned

10. Certification(s) license(s) held:

11. You feel comfortable providing (select one or both) (Required.)

12. How many mentees would you like to work with at one time?

13. You feel comfortable mentoring (choose one or both)

14. Please describe your career path. Think of the major jobs you have held and list the titles in sequential order. This will give mentees an idea if you have followed a similar career path to the one they are on. For example: lab tech, child health consultant, chemist, lab supervisor.

15. Years you have worked in the water industry

16. Describe what you do on a day-to-day basis at work.

17. Do you have any previous experience mentoring? If yes please explain.

18. What specific qualities, skills, or other attributes do you value in yourself and that you feel will be beneficial to a mentee?

19. Describe what you consider to be your strongest technical and professional competencies, for example, pump maintenance, networking skills, career planning, water quality, etc.:

20. How much time would you like to devote to mentoring? (select one)

21. How far are you willing to travel to meet with your mentee? (select one)

22. What do you think will be the most challenging aspect of being a mentor?

23. What do you hope to gain by being a mentor?

24. What do you like to do when you are not at work?

25. What are your expectations for this mentoring experience?

26. Is it okay for the ISAWWA Mentoring Program administration to communicate with you via email?