WISE Mentor Application

MENTOR APPLICATION
Applicant name*

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Will this be your first time participating in a mentoring program?*

YesNo
If no, in what capacities have you served as a mentor or had a mentor yourself, and what was your experience like?
What STEM area(s) are you able to mentor in?
Next section: Please choose 4 competencies that you have.
Rank them in order of importance- the top item is the competency that you feel you have mastered the most in your career. *
How many hours can you commit to mentoring per month?

1-2 hours3-4 hours5-7 hours
Why do you believe you would be a strong mentor?*
Please provide any other information you believe would be important in review of this application.
Are you willing to undergo a background check as part of this hiring process?

YesNo
Please provide a current resume with cover letter

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Declaration by Mentor

This application has been made by me after having read and understood all the rules of the program.

I declare that the information furnished by me in this application is true to the best of my knowledge and belief.

I agree to observe the rules relating to WISE.

By pressing the Submit Button, I confirm the above declaration and accept the terms and conditions.
Acceptance of Terms & Conditions and Declaration of Mentor
Signature*

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MENTOR APPLICATION

Acceptance of Terms & Conditions and Declaration of Mentor