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Application for Mentoring Program

Registration Information

Fields in red are required.

Mentors:
There is no cost to become a mentor, however it is required that all mentors be dues paid WIT members.

Protégés:
After being accepted into the program, the $200 program fee will need to be paid prior to the first session. Information about how to make this payment will be provided with your acceptance notice. This program fee is addition the annual WIT membership fee

Terms Of Agreement

Each mentor will commit to attendance at one orientation session and four mentoring sessions during the mentorship term. Each protégé will commit to attendance at one orientation session and four mentoring sessions during the mentorship term.

The mentor will assist their assigned protégé in the process of identifying or investigating a particular career field, advancement or change strategy, and/or alternative approaches to problem solving in a current field of interest to the protégé in which the mentor has specific expertise.

Mentors and protégés will immediately contact the WIT Mentor Program Coordinator regarding any difficulties or conflicts.

Any relationship between mentor and protégé beyond the WIT sponsored Mentor Sessions will be left to the discretion of the mentor-protégé team.

Mentors and protégés will be responsible for completing all evaluation materials and returning them to the WIT Mentor Program Coordinator in a timely fashion.

I understand and agree to comply with the terms outlined above and in the WIT Mentor Program Description. I also understand and agree that neither WIT nor any mentor shall be held responsible or liable for any advice provided to me during the mentorship term.

Agree to the Terms?

Yes

I am applying to be a:

Mentor

Protégé

First Name:

Last Name:

Middle Initial:

Home Address:

Home City/State/Zip:

Home Phone Number:

Home Fax Number:

Email Address:

Occupation / Professional Title:

Name of Business / Organization:

Business Address:

Business City/State/Zip:

Business Phone Number:

Business Fax Number:

Describe your work:

Mentoring Program