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* 1. Name:

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* 2. Preferred Email:

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* 3. Preferred Phone:

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* 4. Mailing Address:

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* 5. Your current company:

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* 6. Position:

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* 7. Field:

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* 8. Type of actuarial work (pricing, reserving, etc.):

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* 9. How long have you worked in the actuarial field?

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* 10. What are your areas of expertise? (ie. Medicare pricing, career transitioning, etc.)?

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* 11. What resources do you bring? (ie. teaching experience, organizing events, developing leadership skills, etc.)

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* 12. In what country were you born? (this may be a common bond with you and a potential mentee)

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* 13. Do you speak any languages in addition to English? (if yes, please list)

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* 14. Are you willing to mentor an international actuary or actuarial student?

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* 15. Are you currently taking exams? (if yes, please specify)

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* 16. Have you attained an Associate or Fellowship designation? (if yes, please specify)

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* 17. If you are finished with all exams, how long ago did you sit for your last exam?

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* 18. Are you familiar with the current exam system? (if yes, please specify SOA, CAS or Other)

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* 19. If you have any suggestions or comments on how we can improve the mentoring program, please feel free to write your comments here:

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