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Speaker Submission
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Mentorship Program
*
First Name
*
Last Name
*
Email
*
Phone Number
*
Are you interested in being a mentor, mentee, or both?
--Please select--
mentor
mentee
both
*
Have you participated in a mentoring program in the past? (Check all that apply)
mentor
mentee
neither
*
What is your current position?
--Please select--
CHRO
VP of Human Resources
Director of Human Resources
HR Generalist
HR Specialist
HR Coordinator
HR Assistant
Other
If other indicate here
*
How many years of HR experience do you have?
--Please select--
1-3 years
3-5 years
5-7 years
7-10 years
10+ years
*
How much time could you commit to mentoring program?
--Please select--
Once per week
Oncer per month
Once per quarter
Other
If other indicate here
*
When you think about communicating with your Mentor/Mentee, how do you envision the relationship?
--Please select--
More casual- we contact each other when we want to talk, knowing that the other person will be available to me when needed.
More structured- set schedule with specific topics
Other
If other indicate here
*
If interested in being a mentor, please list the specialties or areas of expertise you feel you have that can benefit a fellow professional in the Mentor Program? If not interested in being a Mentor at this time, please enter "N/A".
*
If interested in being a mentee, please describe what area(s) of professional development you would like to explore in the Mentor/Mentee relationship. If not interested in being mentored at this time, please enter "N/A".
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