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Please note:  You must be a member in good standing of NYWICI in order to participate as a Mentor

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* 1. First Name

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* 2. Middle Initial

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* 3. Last Name

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* 4. Primary Email Address

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* 5. Mobile Number:

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* 6. Date of Birth

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* 7. Employer

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* 8. Title

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* 9. # of Years in the Workforce

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* 10. Address

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* 11. City, State, Zip

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* 12. My career experience is in the following areas:

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* 13. Have you ever served as a Mentor.

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* 14. What do you feel you can bring to your prospective mentee and to the NYWICI Foundation Mentoring Program? Describe the qualities that make you an effective leader and mentor.

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* 15. Please describe yourself and your career experience.

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* 16. Briefly describe your ideal mentee.

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* 17. Anything else we should know about you?

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* 18. In 2014-2015 we are introducing a more flexible mentoring program. I am interested and able to serve as a mentor for:

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* 19. Would you be interested in Reverse Mentoring: an opportunity for young professionals to mentor seasoned professionals in areas across media and communications (such as print, web, mobile, social, video or data management/analysis)?

Directions: Please answer the questions below and send your current resume or bio via email to Angella Giannacopoulos at AGiannacopoulos@kellencompany.com
I agree, as a potential mentor, to communicate effectively with my mentee, follow up on discussions and follow through for the agreed-to terms of the mentor/mentee relationship. Terms of the relationship. including type/regularity of communication will be set after mentor/mentee matches are made.

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