ISAWWA Mentoring Program - Application to be a MENTOR Mentor Application Hello! We are so excited that you are interested in becoming a ISAWWA Mentor! Please fill out this application so that we can learn more about you and match you with a mentee. OK Question Title * 1. Name OK Question Title * 2. Email address OK Question Title * 3. Mailing Address OK Question Title * 4. City, State and Zip OK Question Title * 5. Company OK Question Title * 6. Phone number (cell) OK Question Title * 7. Phone number (office) OK Question Title * 8. Current job title: OK Question Title * 9. College degree earned OK Question Title * 10. Certification(s) license(s) held: OK Question Title * 11. You feel comfortable providing (select one or both) traditional one-on-one mentoring coaching Other (please specify) OK Question Title * 12. How many mentees would you like to work with at one time? OK Question Title * 13. You feel comfortable mentoring (choose one or both) males females OK Question Title * 14. Please describe your career path. Think of the major jobs you have held and list the titles in sequential order. This will give mentees an idea if you have followed a similar career path to the one they are on. For example: lab tech, child health consultant, chemist, lab supervisor. OK Question Title * 15. Years you have worked in the water industry 0-5 6-15 15-25 26 or more OK Question Title * 16. Describe what you do on a day-to-day basis at work. OK Question Title * 17. Do you have any previous experience mentoring? If yes please explain. OK Question Title * 18. What specific qualities, skills, or other attributes do you value in yourself and that you feel will be beneficial to a mentee? OK Question Title * 19. Describe what you consider to be your strongest technical and professional competencies, for example, pump maintenance, networking skills, career planning, water quality, etc.: OK Question Title * 20. How much time would you like to devote to mentoring? (select one) 1 hour per week 3 hours per month 2 hours per month OK Question Title * 21. How far are you willing to travel to meet with your mentee? (select one) online or phone only 30 minutes 1 hour 2 hours OK Question Title * 22. What do you think will be the most challenging aspect of being a mentor? OK Question Title * 23. What do you hope to gain by being a mentor? OK Question Title * 24. What do you like to do when you are not at work? OK Question Title * 25. What are your expectations for this mentoring experience? OK Question Title * 26. Is it okay for the ISAWWA Mentoring Program administration to communicate with you via email? Yes If no, please explain OK DONE