Mentor expression of interest

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* 1. Please provide your email address

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* 2. Please provide your name (first and last)

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* 3. What is your primary role?

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* 5. How many years have you formally mentored?

0 3 6+ years
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i We adjusted the number you entered based on the slider’s scale.

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* 6. What area do you want to mentor in?

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* 7. Would you prefer to mentor in-person or remote (i.e phone or online)?

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* 8. Do you have access to a stable internet or phone connection for remote mentoring?

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* 9. What do you want to get out of this program?

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* 10. Do you give permission for your contact details to be sent to your matched mentee?

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* 11. Do you consent to the Upstairs including any feedback you provide or specific examples from your mentoring experience in promotional material?

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