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* 1. Full Name (First Name, Last Name)

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* 2. Please select your gender

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* 3. What is your age?

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* 4. Job Title

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* 5. Company/Organisation

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* 6. Phone Number

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* 7. Email Address

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* 8. How did you hear about the ACiiTC Mentoring Program?

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* 9. Which category interests you?

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* 10. In 25 words or less explain what stage of your career/ business you are in (i.e beginning, concept or looking to progress to another stage)

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* 11. In 250 words or less tell us why mentoring would benefit you

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* 12. Would you be able to commit to 1 meeting a month?

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* 13. Have you been involved in a mentor/mentee program before? 

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* 14. If you answered yes to Q13, which program were you involved in?

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* 15. What goals are you looking to achieve from the mentoring program?

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* 16. Any other comments or information you would like to share?

0 of 16 answered
 

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