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* 1. First Name

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* 2. Last Name

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* 3. Company

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* 4. Email 

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* 5. Home zip code

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* 6. Company Zip Code

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* 7. Type of firm I work for is best described as 

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* 8. FPA Member Since

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* 9. FPA Membership Type

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* 10. I currently hold the following designations and securities licenses

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* 11. I am currently in good standing with all entities monitoring the designation indicated above

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* 12. How involved are you in the financial planning process at your current firm?

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* 13. How many years of experience do you have practicing the elements
of financial planning?

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* 14. Are you a career changer and if so from which field?

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* 15. Do you currently work as part of a team or independently?

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* 16. In what areas do you consider to be your strengths

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* 17. In which areas would you be looking to develop greater competency?

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* 18. What would you hope to accomplish by being mentored through the MentorMatch Program? (career path development, educational needs, business development, practice managment, etc.)

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* 19. Have you participated in the mentorship program in the past? if yes, what made it successful or unsuccessful?

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* 20. Please share if you have any limitations regarding your ability to
participate in the program. i.e. time constraints, language or accessibility barriers.

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* 21. What else would you like the FPA of NE know that would help them choose you for participation?

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* 22. I understand that clicking this box constitutes as a legal signature 

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