UWPIAA Mentoring Program – Application – Up With People International Alumni Association

Mentorship Program Application

Name(Required)

First Last

Preferred Name

Email(Required)

Phone(Required)

Cast Year

Other Casts

Any other casts you travelled in.

Birth Country(Required)

Country

Current Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Current Time Zone(Required)

Current Profession(Required)

Current Job Title(Required)

I'm applying to be:(Required)

Mentor

Protégé

Pick one or both

FOR MENTORS

As a Mentor, I have the following skills and/or experience to offer to a fellow alum:

Please outline any preference for country, language, experience level (or other qualities or skills) of your Protégé

Please outline any preference related to time zone (for example – maximum 6 hours apart)

FOR PROTÉGÉS

As a Protégé, I am interested in learning the following skills and/or experiences from another alum:

Please outline any preference for country, language, experience level (or other qualities or skills) of your Mentor

Please outline any preference related to time zone (for example – maximum 6 hours apart)

I ACKNOWLEDGE AND AGREE THAT:

Commitment(Required)

I have read the program details and expectations outlined on www.UWPIAA.org/Mentoring and commit to fulfilling the requirements

Email(Required)

I authorize UWPIAA to share my email and phone number with my assigned partner for the sole purpose of connecting for mentoring.

Requirements 3(Required)

Mentor and protégé matches may not include all identified skills, experience or preferences, however the UWPIAA Mentoring Program team will do their best to fulfill these requests.

Phone

This field is for validation purposes and should be left unchanged.