This intake form should take approx. 8-10 minutes to complete. By completing this intake form, you are expressing your commitment to participating in the Mentorship Program- 2027 Cohort. Intake forms will be used to match you with your mentor/mentee.

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1. First Name (Required.)

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2. Last Name (Required.)

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3. Department (Required.)

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4. Email (Required.)

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5. First Name of your Direct Supervisor (Required.)

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6. Last Name of your Direct Supervisor (Required.)

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7. Work Phone

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8. What is your current role? (Required.)

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9. How long have you worked for the City of Madison?

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10. How long have you been in your current role?

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11. In your current role do you supervise other employees?

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12. What is your primary workplace location?

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13. Are you committed to advancing the programs of Leadership Development, equity, and learning through your active participation? 

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