Community Development Mentoring Program 2014 Application

Program Description and Application

The Community Development Mentoring Program is designed to promote and support a culture of learning and mentoring within the community development field. In doing so, the program seeks to enhance the preparation of mid to senior level professionals of color, who demonstrate leadership potential, for advancement and growth into positions of leadership and authority, by facilitating effective and meaningful relationships between and amongst community development professionals.

Please fill out this form, indicating in Question #4 whether you are interested in serving as a mentor or a mentee. Keep in mind that this information will be made available to potential mentees for matching purposes only. Please be open and honest about what you are seeking in a mentee and what you hope to gain from this experience. Applications are due by June 15,2014.

Applicants are encouraged to submit early in order to schedule an interview and ensure optimal matching.

Applicants will be notified of their mentor/ mentee the first week of August 2014.

Question Title

1. Personal Information

Name:

Organization:

Current Position/Title:

Years in Current Position:

Email Address:

Organization Address:

Organization Phone:

Years in Community Development:

Fax:

Gender:

Language(s) (please list languages you are fluent in):

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2. Age

under 30

31-40

41-55 years

56+

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3. What is your race or ethnicity?

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4. Do you have a mentor/ mentee you would like to pair with for the program?

Name:

Email:

33% of survey complete.