Mentee Application

Phone

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MENTEE APPLICATION

Mentoring is a unique partnership between two people based on a commitment to the Mentoring process, common goals/expectations of the partnership, mutual trust, and respect. Mentoring is both a “Get and Give” experience with the goal of providing a rich and rewarding experience for both partners. Please complete the below form and click "submit." The form will be emailed to the program director - Debbie Kalinyak at peaceful4deb@gmail.com.

Name*

First Last

Professional Degree

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Region*

Specialty Region*

Email*

Home Phone*

Work/Mobile Phone*

Best Way & Time to Contact:

Do you have a license or training in a particular profession?*

If you do have a license or training in a particular profession, in which state/country?

What do you hope to learn from a mentor?

Do you have a particular person in mind to be your Mentor?

If you do have a person in mind to be a mentor, please list their name below:

What are some of the qualifications you would like to have in a Mentor?

What Christian Faith Tradition do you practice?

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