CHARA MENTOR PROGRAM Question Title * 1. Personal Information (Required.) First Name Middle Initial Last Name Year of Graduation Contact Email Address for the Mentor Program Contact Phone Number for the Mentor Program Question Title * 2. What state do you reside in? (Required.) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia (DC) Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming City or Town? Question Title * 3. Are you volunteering to be a Mentee or Mentor (Required.) Mentee Mentor Question Title * 4. Can you commit to at least one Zoom or phone meeting per month with your Mentee/Mentor? (Required.) Yes No Question Title * 5. What Industry or Field of Expertise do you work in or intend to purse? (Required.) Question Title * 6. What was/is your academic area of study at Holy Cross? (Required.) Question Title * 7. What are your personal interests or hobbies outside of work or school Interests: Hobbies: Question Title * 8. Do you agree to a code of conduct that is mutually respectfully of time, privacy and behavior? (Required.) Yes No Done
