Application For Potential Mentors/Mentees
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You may e-mail questions and comments to: judith.lentin@thementors.com.

(Please make sure to fill in the required field *'E-MAIL ADDRESS'.)
ESSENTIAL INFORMATION:
   
APEGGA MEMBERSHIP
EMPLOYER PERMISSION

I wish to apply for registration as a:

And wish to be matched in in

   
1. PERSONAL INFORMATION:    Mr.   Ms.   Dr.
LEGAL LAST NAME:
LEGAL FIRST NAME:
PREFERRED LAST NAME:
PREFERRED FIRST NAME:
HOME
ADDRESS :
 
CITY:
PROVINCE:
POSTAL CODE :
TELEPHONE:
FAX:
E-MAIL ADDRESS: *
BUSINESS
COMPANY:
BUSINESS ADDRESS :
 
CITY:
PROVINCE:
POSTAL CODE :
TELEPHONE:
FAX:
E-MAIL ADDRESS: *REQUIRED

PREFERRED ADDRESS: HOME BUSINESS OTHER

IF OTHER,

2.  POST SECONDARY EDUCATION

INSTITUTION:
LOCATION:
DATES ATTENDED:
FROM: TO:
DATE GRADUATED:
DEGREE TITLE:
SPECIALIZATION:

INSTITUTION:
LOCATION:
DATES ATTENDED:
FROM: TO:
DATE GRADUATED:
DEGREE TITLE:
SPECIALIZATION:

INSTITUTION:
LOCATION:
DATES ATTENDED:
FROM: TO:
DATE GRADUATED:
DEGREE TITLE:
SPECIALIZATION:
3. EXPERIENCE

Please attach a current resume outlining the following:

        * Company names and locations
        * Employment dates
        * Names of Supervisors
        * Positions titles
4.  REFERENCES
These individuals must be familiar with the significant time elements of your experience (if applying for Professional Membership).
NAME
RELATIONSHIP
PROFESSIONAL STATUS
CONTACT INFORMATION
NAME
RELATIONSHIP
PROFESSIONAL STATUS
CONTACT INFORMATION
NAME
RELATIONSHIP
PROFESSIONAL STATUS
CONTACT INFORMATION
   
5.  APEGGA MENTORING PILOT PROJECT
1. Why do you think you should be selected as a participant.
2. What specific characteristics are you looking for in a mentor or mentee?
3. What types of volunteer positions have you held in the past?
 
3. Do you have any special interest or hobbies that might be of interest to a prospective mentoring partner?
4. Have you participated in a mentoring program in the company you now work for, and if so, who is the Mentoring Coordinator?
5. Approximately how many APEGGA members work in the same company at the same location with you?
6. Have you received permission from your company to participate in this APEGGA program?


Mentees profit from identifying particular areas of knowledge and skills they want to develop with the help of their mentors. Please review the following examples and answer the appropriate questions. Please note that these are examples only, feel free to add any topics you wish.
  • Technical expertise
  • Advancing in my career
  • Balancing work and outside priorities
  • Bouncing back from failure
  • Building a shared vision \
  • Changing careers
  • Coaching
  • Communicating persuasively
  • Dealing with difficult people
  • Desktop publishing
  • Designing Web sites
  • Developing policy
  • Giving corrective feedback
  • Handling customers
  • Making oral presentations
  • Managing projects
  • Motivating people
  • Negotiating
  • Recruiting and hiring
  • Resolving conflicts
  • Taking risks
  • Teambuilding
  • Training
  • Understanding organizational politics
  • Using computer software
  • Writing effectively
  • Other:
a. (Prospective Mentors): What skills, knowledge, or opportunities could you provide in this mentoring program?
 
b. (Prospective Mentees): What skills, Knowledge or other benefits do you hope to gain by participating in the program?
 
It is currently considered that the most effective way to match mentors and mentees among the more than 6,000 members in the Calgary region is to use the APEGGA database. In order to use the information in the database we need your permission for limited access to that information.


I agree I do not agree to have the information I supplied on APEGGA membership forms and annual updates to be used in the mentor matching services.

 

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