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Mentor Application
Women Who Inspire Mentoring Program
First Name
Last Name
Email
Code
Phone
Street Address
Street Address Line 2
City
Region/State/Province
Postal / Zip code
Country
Country
Do you currently live or work in Maui County, Hawaii? If no, please contact us for more info. We currently serve the Maui County region.
Yes
No
Pronouns
How did you find out about Woman Who Inspire Mentor Program?
Add answer here
What do you hope to get out of the mentoring experience?
Do you have any previous experience volunteering or mentoring? * If so, please describe.
What qualities, skills, or other attributes do you feel you have that would benefit a young woman in formulating and achieving her education, career, and personal goals?
Describe yourself in 2-3 words.
What are your hobbies and how do you like to spend your leisure time?
Are you currently employed? * Select all that apply.
Yes
No
Actively looking
Retired
Unable
What industry or field is your specialty?
The Woman Who Inspire Mentoring program requires commitment and perseverance. Are you willing to accept the following program requirements? Please check each requirement as you agree to it
Actively participate for a minimum of three months
Attend a Meet and Greet workshop
Attend an initial mentor orientation session
Complete the code of ethics and training
Meet with my mentee weekly or bi-weekly
Maintain contact with my mentee in person or by phone at least once a week
Communicate regularly and openly with program staff
Participate in program assessments
Receive and objectively consider feedback regarding any difficulties during my participation in the mentoring program
All of the above
Please explain any particular issues that would challenge your ability to keep the above commitments.
Have you ever been convicted of a crime? * If so, what were the circumstances?
Have you ever received treatment for alcohol or substance abuse? * If yes, then please explain. This is not a deal breaker.
Anything else you'd like to share?
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