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2024-2025 Mentor Program Application
**Please complete application only if you have received prior
authorization from your Pool Administrator to participate in the program.**
Applications due no later than August 30, 2024.
*
1.
I would like to participate as a:
(Required.)
Mentor
Mentee
*
2.
Name
(Required.)
*
3.
Pool Name
(Required.)
*
4.
Email address
(Required.)
*
5.
Position/Title
(Required.)
*
6.
Please choose the functional-area that most closely aligns with your position:
(Required.)
Business/Data Analysis
Claims
Finance/Accounting
Health/Wellness
Human Resources
Information Technology
Law Enforcement Loss Control
Legal
Loss Control
Marketing/Communications
Pool Administration
Underwriting
Other (please specify)
*
7.
Time in your current position:
(Required.)
*
8.
Number of years in pooling:
(Required.)
*
9.
Please describe your current role and responsibilities. If you have other industry experience, please list that as well.
(Required.)
10.
What do you hope to gain through this mentor program?
11.
Additional comments/questions/etc.
