Mentor Application Form

NWIIWA Mentor Application
What’s Expected of You

The program is intentionally designed to respect your time while creating a meaningful experience for your mentee.

Mentors commit to:
- A minimum of four 1-hour mentoring sessions
- Attending the in-person Kickoff Celebration
- Responding consistently to your mentee’s communication
- Completing brief program check-ins
- Communicating with the Mentorship Committee if challenges arise
- Participating in graduation/recognition when possible
Your mentee is responsible for initiating and scheduling meetings, but a successful mentoring relationship requires engagement from both participants.
Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email
example@example.com
Title
Company
Title
Phone Number
Format: (000) 000-0000.
Are you a NWIIWA Member
Briefly describe your professional background and areas of expertise.
What industries or sectors do you have experience in? (List all that apply.)
How many years of professional experience do you have?
Have you previously served as a mentor (formally or informally)?
If yes, briefly describe your mentoring experience.
What professional skills or topics are you most comfortable mentoring someone in?
Why are you interested in serving as a mentor in the NWIIWA Mentoring Program?
Are there particular areas you would prefer NOT to mentor in?
How would you describe your communication style?
How would you describe your mentoring style? (Select all that apply.)
Are you willing to attend the required program events (Kickoff, Professional Development Sessions, and Celebration)?
Are you okay matching with a mentee outside of your industry?
Matching Process

Mentors and mentees will be thoughtfully paired based on:
- Professional experience and industry alignment-If applicable
- Career interests and growth goals
- Communication and engagement preferences.
I understand that while the NWIIWA Mentorship Program is mentee-driven, meaningful mentorship requires engagement from both participants. If selected, I commit to being present, responsive, respectful of my mentee’s goals, willing to provide honest and constructive feedback, and communicative with the NWIIWA Mentorship Committee if support is needed.
If selected, do you agree to actively engage with your mentee and uphold the NWIIWA Mentoring Program Code of Conduct?
Would you like to be considered for future co-horts?
What do you personally hope to gain from serving as a mentor?
Is there anything else you'd like us to know about you as we match mentors and mentees?
Should be Empty:

NWIIWA Mentor Application