AAUW/CDG Mentoring Program Online Application

Name	*
Street	*
Apt
City	*
State	*
Zip Code	*
Phone
Email Address
Ethnicity
Gender	*	F M
Number of Years in the Community	*
I am applying to be:	*	a mentor a protege
What are your goals and/or expectations of the mentoring program?	*
What kind of knowledge and/or experiences do you have that may benefit your mentor/protege?	*
Mentor applicants: What are the strengths that would make you a good mentor?
Protege applicants: What benefits do you anticipate from participating in this program?
Tell us more about you. (Personal interests, activities, expertise, etc.)	*
What are some of the concerns/issues you believe underrepresented members of our community have to manage?	*
Do you prefer a mentor/protege of the same gender?	*	Yes No No Preference
If we cannot meet your request, would you still like to participate in the program?	*	Yes No
How many hours are you able to commit to this program each month (including AAUW/CDG sponsored program activities)?	*	1-2 hours 2-3 hours 3 or more hours
When would you most often be able to meet with your mentor/protege?	*	Before work Over lunch After work Weekends During business hours
Do you have a preference for the ethnicity of your mentor/protege?	*	Yes No
If we cannot meet your request, would you still like to participate in the program?	*	Yes No
Do you know someone who would be an idea candidate to serve as a mentor? Please provide his/her name, phone number, and email address so we may contact them about their personal interest:
Name
Phone
Email

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Community Diversity Group | 2006-2008