Mentor/Mentee Signup Form

Account Login

Mentor/Mentee Signup Form

Women in HVACR

Mentoring Program Questionnaire

Name:

Street Address:

City:

State:

Zip:

Phone Numbers

Home:

Work:

ext:

Cell:

Emails

Work:

Home:

Contact Preference (phone, email, etc...)

Employer:

Years in the Industry:

Job Title/Description:

List your Career Goals:

List your Interests/Hobbies:

List any active Memberships/Associations (include the year which you joined):

Are you looking for a mentor or mentee?
Mentor Mentee

List details for any previous mentee experience (have you been a mentee before, was it a positive experience, why/why not, etc.):

List details for any previous mentor experience (have you been a mentor before, was it a positive experience, why/why not, etc.):

Mentor/Mentee communication preferences

Please rank the following options in order of preference for you concerning how communciation will be handled between mentor/mentee (1 is the highest, 4 is the lowest)

Face-to-face

Email

Phone

Skype

Please indicate to us which three days would work best for you in regards to mentor/mentee communications

First Day Choice

Second Day Choice

Third Day Choice

Please indicate to us which three times would work best for you in regards to mentor/mentee communications on the days chosen above

First Time Choice

Second Time Choice

Third Time Choice

Please rank the following options in order of preference for you concerning how offten communciation will be handled between mentor/mentee (1 is the highest, 4 is the lowest)

Monthly

Bi-Monthly

Weeky

Please include, in the space below, any comments that the rest of the form did not allow you to properly express.