MENTOR APPLICATION
Mentor Name
*
First Name
Last Name
Company
*
If retired, please state the last company you worked.
Title
*
If retired, please put retired as your title.
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you a CPA?
*
Yes
No
Year your license was received.
*
List any special qualifications, certifications, awards, etc.
Linkedin URL
How did you hear about the Mentor Program
*
Email
Social Media
Colleague
FICPA Employee
If you heard about the program from another person (colleague, FICPA Employee, etc.) please provide their name.
How many years of experience do you have:
*
2-5
6-10
11-15
16-20
21-25
26+
Your accounting/CPA experience includes positions held within the following firms or industries:
*
Big Four Accounting Firm
Regional Accounting Firm
Small Accounting Firm
Athletic & Outdoor
Consulting
Consumer Products
Education
Energy & Utilities
Financial Services
Food & Beverage
Government
Healthcare
High Tech
Manufacturing
Marketing
Non-Profit
Real Estate
Retail
Social Enterprise
Will this be your first time participating in a mentoring program?
*
Yes
No
If no, in what capacities have you served as a mentor or had a mentor yourself, and what was your experience like?
Rank these competencies in order of importance that you feel are most important to work on during a mentoring period.
*
Other areas you feel are important to work on that are not listed.
*
Why do you believe you would be a strong mentor?
*
Can you commit to meeting with your mentee for at least one hour, once a month?
*
Yes
No
Please provide any other information you believe would be important in review of this application.
Please upload your resume.
*
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