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Please note:  You must be a member in good standing of NYWICI in order to participate as a Mentor (i.e. dues current)

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* 1. First Name

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* 2. Middle Name

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* 3. Last Name

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* 4. Primary Email Address

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* 5. Date of Birth

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* 6. Employer

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* 7. Title

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* 8. # of Years in the Workforce

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* 9. Home Address

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* 10. City, State, Zip

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* 11. My career experience is in the following areas:

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* 12. Have you previously participated in a formalized Mentoring program?

Directions: Please answer the questions below and send your current resume or bio via email to Ellery Moses at EMoses@kellencompany.com

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* 13. What do you feel you can bring to your prospective Mentee and to the NYWICI Foundation Mentoring Program?

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* 14. Please describe yourself and your career experience.

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* 15. Briefly describe your ideal Mentee.

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* 16. Anything else we should know about you?

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* 17. This year, the mentoring program will kick off with a Speed Mentoring event on August 5, 6-8pm when matches will be made. Are you able to attend? If so, please register at http://www.nywici.org/speed-mentoring

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