Mentor Program Application
To apply to join the WALSAA Mentor Program as a mentor or mentee, please complete and submit this form.
Full Name
*
First Name
Last Name
Degree(s)/Major(s)
*
Certificate(s)
Select One
*
Alumni
Freshman
Sophomore
Junior
Senior
Grad student
FISC student
Graduation Date/Anticipated Graduation Date
*
Are you considering any type of grad school?
Job Title
Employer
Your Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Preferred Communication Method
*
Email
Text
Phone
Career/professional interests
*
Please share current and previous careers, professional interest and involvement, career aspirations and goals.
Are you interested in
*
Mentor
Mentee
Both
Do you have a specific WALSAA member or student you would like to be matched with?
Mentees: What do you hope to gain from WALSAA's Mentor Program?
Mentors: What do you hope to share with WALSAA's Mentor Program?
Questions filling out this form? Please contact Stephanie Hammerly, WALSAA Membership and Events Coordinator at 608-438-1994 or admin@walsaa.org.
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