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* 1. Company

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* 2. Department

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* 3. Name:

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* 4. Title:

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* 5. At what email address would you like to be contacted?

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* 6. Please provide a brief description of your education and/or career history and special interests.

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* 7. What are your most rewarding personal and/or professional achievements to date?

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* 8. What are your strongest skills, knowledge, or experience that would be helpful to a mentee?

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* 9. List 3 words that would best describe your management style.

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* 10. What are your expectations of the WICT Southeast Student Mentoring Program?

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* 11. Have you previously participated as a mentor in the WICT Southeast Student Mentoring Program?

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* 12. Participation Level

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