Mentors, Advisors, and Peers (MAPs) for DC/Baltimore WIB for WIB Members
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1. MAPs Questionnaire (MUST BE A WIB-MEMBER)
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1
. Please provide the following information: (Only MAPs committee members and WIB leadership will have access to this information.)
Please provide the following information: (Only MAPs committee members and WIB leadership will have access to this information.)
Name:
Company and Title and Years in Position:
Preferred Mailing Address:
City:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP:
Preferred Email Address:
Preferred Phone Number:
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2
. Affiliation/Employer Type?
Affiliation/Employer Type?
Academia
Government
Biotech/pharmaceutical/medical device company
Service Provider: Law Firm/Financial Services/Consulting Firm/Contract Research/Contract Manufacturing
Other:
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3
. Please select two key issues that you would like to discuss in your MAP group.
Please select two key issues that you would like to discuss in your MAP group.
Entrepreneurship
Raising capital
Leading/running a company
Managing a team or department
Working in a male-dominated culture
Career planning
Transitioning careers
Work/family balance
Other (please specify)
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4
. MAPs groups are 6 - 10 women that meet to discuss topics important to their career growth and professional development. A MAPs group leader will email their group to organize the first meeting. Each group can have several leaders.
Are you interested in being a group leader?
MAPs groups are 6 - 10 women that meet to discuss topics important to their career growth and professional development. A MAPs group leader will email their group to organize the first meeting. Each group can have several leaders. Are you interested in being a group leader?
Yes
Maybe, please keep me on the email list
No
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5
. What is your preferred meeting location? Please mark your first and second choices with a 1 and a 2. (all fields must have a number in them so please finish filling out the ranking)
What is your preferred meeting location? Please mark your first and second choices with a 1 and a 2. (all fields must have a number in them so please finish filling out the ranking)
Baltimore
Howard County
Prince George's County
Montgomery County-Chevy Chase/Bethesda/Silver Spring
Montgomery County-Rockville/Gathersburg/Germantown
Frederick County
Washington, D.C.
Northern Virginia-Alexandria/Arlington
Northern Virginia-Vienna/Reston/Fairfax
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6
. What is your preferred meeting time for location choice 1? Please mark your first and second choice with a 1 and a 2.(all fields must have a number in them so please finish filling out the ranking)
What is your preferred meeting time for location choice 1? Please mark your first and second choice with a 1 and a 2.(all fields must have a number in them so please finish filling out the ranking)
Weekdays: Early morning (e.g., 7:30am)
Weekdays: Noon
Weekdays: Evening (e.g., 6:00pm)
Weekends: Early morning (e.g., 7:30am)
Weekends: Noon
Weekends: Evening (e.g., 6:00pm)
Other
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7
. What is your preferred meeting time for location choice 2? Please mark your first and second choice with a 1 and a 2.
What is your preferred meeting time for location choice 2? Please mark your first and second choice with a 1 and a 2.
Weekdays: Early morning (e.g., 7:30am)
Weekdays: Noon
Weekdays: Evening (e.g., 6:00pm)
Weekends: Early morning (e.g., 7:30am)
Weekends: Noon
Weekends: Evening (e.g., 6:00pm)
Other
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8
. MAPs-University groups may be formed as a way for WIB members to mentor graduate students about career development while fostering relationships. MAPs-University group meetings would occur in the evening at the university and interested WIB members would be eligible to attend as many or as few meetings as they choose.
Are you interested in being part of a MAPs-University group?
MAPs-University groups may be formed as a way for WIB members to mentor graduate students about career development while fostering relationships. MAPs-University group meetings would occur in the evening at the university and interested WIB members would be eligible to attend as many or as few meetings as they choose. Are you interested in being part of a MAPs-University group?
Yes
No
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9
. At which university would you be interested in taking part of a MAPs-University meeting? What is your preferred meeting time? How often would you be available to meet? If not applicable please put N/A.
At which university would you be interested in taking part of a MAPs-University meeting? What is your preferred meeting time? How often would you be available to meet? If not applicable please put N/A.
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10
. Why are you interested in joining a MAP group? Please share any other comments that will help in assigning you into your group. If not applicable please put N/A.
Why are you interested in joining a MAP group? Please share any other comments that will help in assigning you into your group. If not applicable please put N/A.
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