Orange Country ASSP Mentee Application

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* 1. Full Name (First and Last)

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* 2. Work and Cell Phone

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* 3. Email Address

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* 4. Major and Year in School

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* 5. Student Section ASSP #

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* 6. Are you willing and able to commit to a mentorship program for one year?

Yes

No

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* 7. Why would you be a good mentee?

Enthusiasm and respect for safety industry

Positive attitude and driven to learn

Willingness to learn skills, knowledge, expertise

Can commit at least 1 hour per week to my mentee

I am willing to take personal interest in the mentoring relationship

Value the opinions of others

Set and meet ongoing personal goals

I need a job

Other (please specify)

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* 8. Have you ever been a mentee?

Yes

No

If yes, explain

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* 9. Briefly describe 3 areas of professional development in which you would like to be mentored.

Area 1

Area 2

Area 3

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* 10. Can you attend September 18, 2019 Mentor Mixer?

Yes

No

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* 11. List 3 reasons why you would be a good mentee?

Reason 1

Reason 2

Reason 3