NATAS-MN
Mentoring Sign-Up Form

(For NATAS members only)

Please complete this form, even if you are not certain about your membership.
If you are not a member, we will contact you to get you signed up.

 
  
  

Personal Information


Name:


Station:


Position/Title:


Address:


State:


Zip:


Phone:
ext:


Fax:


Email:

Years Experience:

Please explain where you would like to be, or what you would like to be doing, in five years.


Career Information

CURRENT JOB:

Dates of Employment:

List Duties:


PREVIOUS JOB:
(Please list only those pertinent to your career.)

Title:

Dates of Employment:

List Duties:


Why would you like a mentor?


What do you hope to learn from the mentor?


How do you see the mentor assisting you in achieving you career goals?


How often would you like to communicate with your mentor?
Weekly Monthly Other (please explain below)


Other:


How would you like to communicate with your mentor?
Email Phone Both


Please list any other information you think the mentor should know about you: