IU Northwest Professional Mentoring Program: Become a Mentor

Name First Last
Email
Preferred Contact Number - Area Code - Prefix Line Number
What contact number is the preferred number? Home Mobile Office
Best time to call *
Are you currently employed? Yes No
Current Job Title *
Brief summary of job responsibilities
Company or Organization *
Company or Organization Address
Type of Company or Organization
Industry and Mission Statement
What is your area of expertise?
Are you currently a member of any professional organizations? Yes No
Please provide the name of the organization and your role in that organization.
What university or college did you attend?
What was your major?
Please list any certifications you may hold.
Ex: Teaching Certificate, Project Management Certificate
Have you previously served as a professional mentor? Yes No
Why do you want to be a mentor at IU Northwest?
How did you learn about the IU Northwest Professional Mentoring Program?
What is your affilation to IU Northwest? Alumni Employee Friend of IU Northwest