WSM Mentorship Program Survey Question Title * 1. Contact info Name Company and Title City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK Question Title * 2. Would you like to be a Mentor or Mentee? Mentor Mentee Both Unsure OK Question Title * 3. Do you work in Streaming Media? Yes No OK Question Title * 4. How are women perceived in your company? OK Question Title * 5. Are there any women mentorship or networking programs at your company? Yes No OK Question Title * 6. How did you hear about the Women in Streaming Media mentor program? OK Question Title * 7. Please outline your current position with responsibilities OK Question Title * 8. What areas would you like to mentor/mentee in? Promotion Branding Problem Solving Communication Issues Image Other OK Question Title * 9. Are you willing to devote an hour of time with your mentor/mentee every two weeks with action items between for a six month program? Yes No OK Question Title * 10. What are you looking for in a mentor/mentee and Is there anything else that you would like to describe about yourself that may help us find the best mentee/mentor for you? OK DONE