Alumni Mentorship Program Application

1. ALUMNI Mentorship Program Application

The following information will be used to create Mentor/ Mentee relationships. Thank you in advance for taking the time to fill out the application and consider being a mentor. We appreciate it!

1. Please fill in the following information:

Please fill in the following information: Name:
Graduation Year:
Degree(s):
Minor:
Years of Experience Prior To Getting M.B.A.:
Current City of Residence:
Current State of Residence:
Male or Female (M/F):
Phone Number 1:
Phone Number 2:
E-mail:

2. Please fill in the following information as it relates to your current position:

Please fill in the following information as it relates to your current position: Company:
Title:

3. Please choose the industry and function that you currently work in:

	Industry	Function
Select One from the drop down menu's.	Please choose the industry and function that you currently work in: Select One from the drop down menu's. Industry	Function

4. Please fill in your most recent past employer(s) and position(s):

Please fill in your most recent past employer(s) and position(s): Past employer 1:
Past position 1:
Years experience:
Past employer 2:
Past position 2:
Years experience:

5. Please select the areas you would like to work on with your student. Select all that apply.

	Select all that apply.
Assisting student with his/ her career development (career goals, resume review, mock interview, etc.)	Please select the areas you would like to work on with your student. Select all that apply. Assisting student with his/ her career development (career goals, resume review, mock interview, etc.) Select all that apply.
Networking (provide contacts for possible internships, connect the student with other individuals who may assist them)	Networking (provide contacts for possible internships, connect the student with other individuals who may assist them) Select all that apply.
Externship opportunities (shadow you for a day(s), assist in a project, allow a student to sit in on a meeting, etc.)	Externship opportunities (shadow you for a day(s), assist in a project, allow a student to sit in on a meeting, etc.) Select all that apply.
Share personal experiences (your career path, ups and downs, relationships that have benefited you, etc.)	Share personal experiences (your career path, ups and downs, relationships that have benefited you, etc.) Select all that apply.
Share industry/ organization experiences (experiences at a particular firm or within a specific industry, company culture, industry insights, and professional associations)	Share industry/ organization experiences (experiences at a particular firm or within a specific industry, company culture, industry insights, and professional associations) Select all that apply.
In-person meetings (go out to lunch, attend a class with the student, invite the student to an industry or company sponsored event)	In-person meetings (go out to lunch, attend a class with the student, invite the student to an industry or company sponsored event) Select all that apply.
Other information (suggest reading materials, hobbies, etc.)	Other information (suggest reading materials, hobbies, etc.) Select all that apply.

Other (please specify)

6. How many mentees would you be willing to take on?

How many mentees would you be willing to take on? 1

7. (Optional) Please describe any interests/ hobbies that you participate in.

(Optional) Please describe any interests/ hobbies that you participate in.

8. (Optional) What professional organizations/ groups are you affiliated wtih?

(Optional) What professional organizations/ groups are you affiliated wtih?

9. Please list any additional information you think would be helpful in matching you with a current student.

Please list any additional information you think would be helpful in matching you with a current student.

THANK YOU FOR YOUR WILLINGNESS TO PARTICIPATE IN THE SIMON MENTORSHIP PROGRAM. WE TRULY VALUE YOUR TIME AND COMMITMENT. WE WILL CONTACT YOU VIA EMAIL TO COMPLETE YOUR PROFILE AND MATCH YOU WITH A MENTEE.