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Interest Survey for Women's Mentorship Program
Survey deadline October 22, 2021.
Please note mentorship groups will begin in the fall (2021). More details to come!
Questions? Contact
Whitnee Dillard here
.
*
1.
Full Name:
(Required.)
*
2.
Are you a Big “I” Member?
(Required.)
Yes
No
3.
Why do you want to participate in a Women's Mentoring Group?
*
4.
Agency Role:
(Required.)
*
5.
Agency Name:
(Required.)
*
6.
Agency Address (including State)
(Required.)
*
7.
Phone Number:
(Required.)
*
8.
Email Address:
(Required.)
*
9.
How did you find out about our Women's Mentorship Initiative?
(Required.)
Big "I" National Communication
Big "I" State Association Communication
Word of Mouth
Other (please specify)
10.
Optional: The Big "I" has special resources for diverse agents identifying as a racial/ethnic minority, young professional (under the age of 40), woman and/or LGBTQ. Please check all that apply and note your response is OPTIONAL.
Woman
Young Professional (Under 40 Years Old)
Racial / Ethnic Minority
LGBTQ
