CFW Banner. Penn State Home. Commission for Women.

Mentor Application Form

Deadline for 2009-10 Applications: Monday, June 15, 2009

Your completed application to the Mentoring Program consists of two parts:

(1) answering the following informational questions
(2) completing a cover letter

You may apply online or print this form and send it, along with your cover letter, to:

Sheila Barlock
Commission for Women
234 Grange Building
University Park, PA 16802
sdc108

Please complete the entire form

First name:
Last name:

Work Unit\Department:

Select One:
Faculty Administrator Staff Exempt Staff Nonexempt Technical-Service 

Work address:  
Work phone:
E-mail:

Title:
Years in current position:
Years employed at Penn State:

Do you prefer to meet: (Check one)
during the work day over the lunch hour evenings and/or weekends

If we are unable to pair you with a protégé with the same time preferences, are you flexible?

Yes No

How did you find out about our program?




Current Skills:

Please check your current skills below:

Financial skills
(please indicate)
 

Skills to Continue to Develop:

Please select five skills below that you would like to develop, with 1=most interested in developing, and 5=interested in developing.

Financial skills
(please indicate)
 


Cover Letter:

Please include the following information in your cover letter, which will aid the committee in learning more about you and assist in the pairing process:

Reason for your interest in the mentoring program as a mentor
List skills and experiences you would like to share with a protégé
List brief career history and accomplishments
Any other information you feel would benefit the committee in finding a match


Please list two professional references: