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MENTEE APPLICATION FORM

Name: Job Title/Company:

Phone: E-mail:

Number of years in business: Age: (optional)

Directions: Please answer the questions below and attach your current resume or bio. Return both items via email to
Lynn Zalokar at [email protected]. Please verify receipt of your application with Lynn by calling her at: (212) 221-7969.

• I understand that this program requires me to commit to spending one (1) hour per month (from
January 2010 to December 2010) with my mentor and I agree to this. Yes [ ] No [ ]
• I understand that I may not be able to be paired exactly to match my request below however I still
would like to participate as a mentee. Yes [ ] No [ ]

Check Box #1 and/or Box #2 (you can do both).


1. [ ] I am applying as a mentee.
2. [ ] I am applying as a Reverse Mentoring Applicant. I would like to offer my technical expertise and a different
perspective to a more senior member.

Questions: Please limit your responses to the space provided below.

1. What do you hope to gain from participation as a mentee?

2. What are some of the challenges in your current job?

3. Describe yourself in three words, describe your ideal mentor in three words:

REQUEST FOR MENTORING PARTNER: Please number the top four areas 1-4 (with 1 being the highest) where you
seek insight/leadership from a mentor. Do not mark more than four (4) boxes. Do not mark 4 boxes in each column!

Businesses Specialties Skills


Advertising [ ] Brand Experience [ ] Commercial Creativity [ ]
Broadcast/Cable [ ] Creative [ ] Career Change/Career Development [ ]
Client/Brand Management [ ] Digital [ ] Diversity/Multi-Cultural [ ]
Corp. Communications/P.R. [ ] H.R./Talent Mgmt. [ ] Networking [ ]
Digital/Interactive [ ] Integrated Media [ ] Talent Leadership/Development [ ]
Marketing/Marketing Services [ ] New Bus. Development [ ] Selling, Negotiation [ ]
Publishing [ ] Relationship Mktg. [ ] Other___________________________ [ ]
Sales [ ] Strategic Planning [ ]
Other ____________________ [ ] Sales/Acct. Mgmt. [ ]
Other ______________ [ ]

If you have any questions either about the program or the application, please contact one of the following committee
members:
 Terry Yoffe: (212) 876-8166 or [email protected]
 Beth Warren: (917) 547-1508, [email protected]

*Please note: Incomplete applications cannot be processed. All participants must be current AWNY members.
If you are interested in becoming an AWNY member please go to www.awny.org and sign up.

Application Deadline: November 2, 2009  Program Begins January 2010

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