Please note:  At this time, only current Student Members or Young Professional Members of NYWICI are eligible for this program.   If you are not currently an active Student or Young Professional Member of NYWICI, you may join online at www.nywici.org/membership.

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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/Age

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* 6. Are you a current Student or Young Professional Member of NYWICI?

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* 7. Are you currently enrolled in college

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* 8. Name of college?

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* 9. Year of Graduation?

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* 10. Are you working?

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* 11. Place of Employment:

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* 12. Title

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* 13. Home Address

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* 14. City, State, Zip

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* 15. My career objectives lie in the following areas:

Directions: Please answer the questions below and send your current resume or bio via email to Meredith Taylor (MLTaylor@kellencompany.com).

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* 16. What do you hope to gain from participation as a mentee?

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* 17. Briefly describe yourself and your goals.

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* 18. Briefly describe your ideal mentor.

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* 19. I understand that due to program limitations I may not be matched with a Mentor at this time.

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* 20. This year, the mentoring program will kick off with a Speed Mentoring event in July 2013 (exact date TBA), when matches will be made. Pending the exact date, do you think you will be able to attend?

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