WiM-VA Mentoring Program Application

WiM-Virginia Mentoring Program Application

To be completed by individuals seeking to participate in the WiM-Virginia Mentoring Program. All application information will be treated confidentially and used only for program purposes. A resume or bio is recommended but not required. By submitting this form, you acknowledge that you have read the Mentoring Program Outline and agree to the guidelines and responsibilities.
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Mentor/Mentee Information
Name*

First NameLast Name
Title*
Email*
example@example.com
Work Phone*
Please enter a valid phone number.
Work Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Information
Company Name:*
Number of Employees
Number of Direct Reports
Please answer each question below:
MentorMenteeBoth
1. What are you hoping to obtain from this mentoring relationship:*
Team-first Corporate CultureElite Corporate CultureHorizontal Corporate CultureConventional Corporate CultureProgressive Corporate Culture
A detailed description for each of the options above is available at: https://www.wimva.com/wp-content/uploads/2021/02/Types-of-Corporate-Cultures.pdf
Work EthicCommunicationSelf-ConfidencePositive AttitudeFlexibilityOrganizationEmotional AwarenessInitiativeTime ManagementNegotiationInnovationLeadershipTeamworkAccountabilitySelf-MotivationStress ManagementCultural FitnessAbility to NetworkSelf-ManagementDecision-MakingOther
4. What characteristics are you looking for in a Mentor/Mentee?*
Example: engineer, from a large company, woman mentor preferred, Northern VA region, etc.
5. Are you aware of any constraints that would prevent you from working with a Mentor/Mentee in a particular company or industry?*
Example: Competitors, Vendors, Subsidiaries, etc.
6. Please provide any additional information that you feel will assist the Mentorship Committee in matching you with a Mentor/Mentee:*
YES - in an informal (ad-hoc) wayYES - in a formal way (structured program)No
8. List any noteworthy professional accomplishments that you would like to share:
A resume or bio is recommended but not required, please add here:

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WiM-Virginia Mentoring Program Application

Mentor/Mentee Information

Company Information

Please answer each question below: