If retired, please state the last company you worked.
If retired, please put retired as your title.
Street Address Line 2
State / Province
Postal / Zip Code
Are you a CPA?
Year your license was received.
List any special qualifications, certifications, awards, etc.
How did you hear about the Mentor Program
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:
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
Energy & Utilities
Food & Beverage
Will this be your first time participating in a mentoring program?
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?
Please provide any other information you believe would be important in review of this application.
Please upload your resume.
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