The NAWLEE Mentoring Program is voluntary for NAWLEE members in good standing. If you elect to participate, you agree to the rules, policies and criteria of the program. It is your responsibility to seek any clarification of the rules, policies and critiera from the program coordinator.

* 1. Please enter the following demographic information:

* 2. I am interested in participating in the mentoring program as:

* 3. List the work that you performed, jobs held, or other work related experience that may give us insight into your skills,knowledge or interests. (ex: agencies, positions held, military etc.)

* 4. Education (Name of institution(s), degree(s), emphasis area):

* 5. Please check any specialized skills you may have:

* 6. Please list any volunteer work you are or have been involved in:

* 7. What is the size of your agency?

* 8. Please check any hobbies or special interests:

* 9. Please check three (3) words to describe you:

* 10. Please check three (3) words to describe a mentor you would like:

* 11. Please check three (3) words to describe a protege you would like:

* 12. Please provide family background (number/order of siblings and any other comments on family you would like to make):

* 13. List prior cities/states/countries you have lived in:

* 14. Please list any other interesting things (likes/dislikes, values, etc):

* 15. Please provide a brief synopsis of your long term goals:

* 16. Please provide a brief synopsis of your short term goals:

* 17. Is there a NAWLEE Member you would like to request by name for your mentor? If so , Please list.

* 18. I agree to participate in the NAWLEE Mentoring Program and agree that my participation is voluntary. By checking below, I agree to abide the the program rules, policy and criteria of the program. Upon receipt of your questionaire you will recevie an email confirmation from the program coordinator.