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Please note:  At this time, only current Student Members or Young Professional Members of NYWICI are eligible for this program.   If you are not currently an active Student or Young Professional Member of NYWICI, you may join online at www.nywici.org/membership.

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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/Age

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* 7. Are you a current Student or Young Professional Member of NYWICI?

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* 8. Are you currently enrolled in an undergraduate or graduate program?

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* 9. Name of college or university

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* 10. Anticipated year of graduation

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* 11. Are you working?

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* 12. If working, are you an intern or employed?

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* 13. Company Name

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* 14. Title

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* 15. Address

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* 16. City, State, Zip

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* 17. My career objectives lie in the following areas:

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* 18. What do you hope to gain from participation as a mentee?

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* 19. Briefly describe yourself and your goals.

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* 20. Briefly describe your ideal mentor.

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* 21. I understand that due to program limitations I may not be matched with a Mentor at this time.

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* 22. In 2014-2015 we are introducing a more flexible mentoring program. Please indicate your preference:

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* 23. 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 (AGiannacopoulos@kellencompany.com).
Terms: I agree, as a potential mentee, to communicate effectively with my mentor, 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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