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NDEAM Disability Mentoring Day Participant Interest Form
Thank you for your interest and availability for the Disability Mentoring Day on Friday, October 23rd from 6:00 PM to 8:15 PM. The event will be held at the H.E.A.R.T. Program located at 707 Lehman Street, Houston, Texas 77018. Please complete the form below and feel free to share with others in your network who may be interested in participating.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Are you interested in serving as a mentor or having a mentor?
I want to serve as a mentor.
I want to have a mentor.
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Mentor/Speaker Registration
This page is for mentors/speakers only. If you selected "I want to have a mentor" on the previous page, please skip this page and select Next.
What is your age range? We will attempt to match you with someone within your same range
*
Please Select
16-18
19-22
22-25
25-28
29-32
32-35
36-40
40+
Do you have previous experience with disability mentorship or related fields?
Yes
No
What is your professional background or area(s) of expertise?
Are you interested in being a speaker, mentoring, or both?
Speaker
Mentor
Both
Of the topics below, which are you most interested in speaking/mentoring about?
Job search
Interviewing
Resume writing
Workplace Culture (i.e., friendships, colleagues, topics of discussion)
Networking (i.e., professional socializing, creating an elevator pitch)
Disability Disclosure and Accommodations
Professional Communication: Phone and Email Etiquette
Starting and Owning a Business
Work-Life Balance
Do you prefer phone, email, text, or remote communication for your follow-up mentor partnership?
Phone/FaceTime
Email
Text
Remote (Zoom, Google Meets, or Microsoft Teams)
What other topics do you believe are important for prospective employment candidates?
Please share any additional information or questions below.
Back
Next
Mentor Partner Registration
This page is for mentor partners only. Please complete the information below so we can match you with the best possible mentor for the event. If you selected "I want to be a mentor", skip this page and select Submit Form at the bottom of this page.
Have you worked with a mentor before?
Yes
No
I am serving as a mentor
What is your age range? We will attempt to match you with someone within your same range
Please Select
16-18
19-22
22-25
25-28
29-32
32-35
36-40
40+
N/A
Do you have a preference for your mentor's gender?
I prefer a male mentor
I prefer a female mentor
I do not have a preference
Not applicable
In order of importance, choose three areas where you need the most support for employment.
Do you prefer phone, email, text, or remote communication for your follow-up mentor partnership?
Phone/FaceTime
Email
Text
Remote (Zoom, Google Meets, or Microsoft Teams)
Please share any accommodations you require.
Submit Form
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