Mentee Application Form

Personal Information

Name ^* (required)

Email Address ^* (required)

Phone Number ^* (required)

State ^* (required)

Are you a member of RIMPA, and if you are, what type of membership do you have?

Professional Information

Current Position ^* (required)

Current Employer ^* (required)

Industry Experience ^* (required)

Mentor Preferences

What experience would your ideal mentor have? ^* (required)

Do you have a preference for a local mentor or no preference? ^* (required)

Expectations

What are your goals for this mentorship program? What would you like to learn from your mentor? ^* (required)