Mentor Application Form

Mentoring could be defined as a developmental relationship in which a more experienced

person provides support and guidance to a less experienced person.

Mentoring goes beyond

the traditional teacher-student relationship: effective mentors serve as advisers, coaches,

teachers, sounding boards, cheerleaders, and critics, all rolled into one. Mentors give those

with less experience an opportunity to improve their understanding of practices, discuss

problems, and analyze and learn from mistakes in an atmosphere that is collaborative,

constructive, and confidential.

---

*The Chief Ideologist suggests that all Mentors have at least five years of experience in the field of being skilled in the art. However, exceptions may be made by the Program Coordinator with due cause.

Please provide the following contact information:

Applicant’s Name:

Title / Occupation:

Institution:

Address:

Telephone:

Email: Preferred method of contact: ___ telephone ___ email

---

To help facilitate an effective mentor/protégé match, respond to the following:

1. Reason(s) for wanting to be a Mentor:

2. Provide a brief summary of your relevant experience:

ie. education, work experience, specialized skills, etc.

3. Is there a particular area / aspect of the profession you would most like to work on with a protégé? If so, please provide details:

4. It is recommended that at least 2 hours each month or 24 hours in one year be set aside for interaction specific to the mentoring relationship. Will it be possible for you to provide this time to the program?

___ yes ___ no

*If no, please indicate the type / amount of time you could commit in a 12 month period:

5. In response to demonstrated interest by our members, the NeckHats mentoring program will try to match members of underrepresented communities with members of similar background if requested. Do you consider yourself to be a member of an underrepresented group? (if so, please elaborate):

E-mail or mail your application to Michael Escamilla C/o Chief Ideologist - NeckHats Mentoring Program Coordinator:

Michael Escamilla me@neckhats.com 504 Spencer Dr Nw Huntsville, Al 35806

Feel free to call with inquires: 503-267-6172 [if !supportLineBreakNewLine] [endif]