FPSA - Mentor Circle Application

Have you ever participated in a mentorship program? *

Yes

No

First Name *

Last Name *

Affiliation (company) *

If retired, please indicate here.

What is your gender?

Female

Male

I Prefer Not to Say

Email *

Mobile *

How much time are you willing to commit to the mentor circle? *

Thirty Minutes, Once a Month

Hour, Once a Month

Hour, Bi-Monthly

OtherOther

What time of day is best for you to do your mentor circle meetings? (Select all that Apply)

Mornings

Afternoons

Evenings

What days work best for you in the circle? (Select all that Apply)

What is your current time zone? *

Do you speak other languages? Are there any languages that you would be comfortable mentoring in?

What do you consider to be your strongest general competencies – include technical knowledge, soft skills, etc.?

What do you think a mentee can learn from you?

What is your education and career history?

A link to a LinkedIn profile can be provided here.

What topics would you be most interested in mentoring on? (Check all that Apply)

List any other topics you would like to discuss:

Can you make it to the Mentor Q&A Session on September 14th, 2022 (3 PM ET)?

Yes

No

This does not disqualify you as a mentor. We may hold additional Q&A Sessions or move this date depending on others' availability. We will allow you to ask questions of the committee and/or the FPSA staff liaison.

Can you make it to any of the following Meet n' Greet Sessions? (Select all that Apply)

First Meet n' Greet - October 6th, 2022 (3 PM ET)

Second Meet n' Greet - November 2nd, 2022 (10 AM ET)

Third Meet n' Greet - November 2nd, 2022 (6 PM ET)

None of the Above

Joining at least one of these events is highly encouraged. However, not joining one of these events does not disqualify you as a mentor.

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Mentor Circle Application – Mentor

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