mentoring-application

Mentoring - 2006 Mentee Application

Click here to download Mentee application

Date:
Name:
Title:
Organization:
Address:
Phone Number:
Fax Number:
Cell Phone:
Email Address:

Please answer all of the questions below:

1. Why are you interested in being mentored? What do you hope to learn?

2. What personal and professional objectives do you hope to achieve through the mentoring process?

3. What qualities are most important to you in a mentor?

Please view the mentors’ profiles and indicate those you would be most interested in being mentored by. Mentees will be assigned to mentors based on developmental interests on a first come, first served basis with input from the mentors. Please mark three choices from below.

Name	Title	Company	3 Choices Mark w/ X
Debbie Egner	SVP, Affiliate Sales and Support	Starz
Sevrin Huff	Senior Manager, IT eCommerce Sales and Order Entry Development	Level 3 Communications
Matthew Moyer	Director, Marketing & Sales	Comcast Corporation
Kelly Percin	Director – System Engineering Release Control Office	Director – System Engineering Release Control Office
Lakshmi Raman	Director, Advanced Technology	CableLabs
Darlene Stapleton	Director of Operations, Customer Care	Time Warner Cable
Michael Turner	VP, Communications and Content	Hitachi Consulting

4. What kinds of people would you most like to be mentored by (e.g., someone in the same functional area, individuals in the same company, individuals at a specific level in the organization, individuals with similar career paths, etc.)?

5. Are there any restrictions on the types of people you would not want to mentored by (e.g., competitor employees, employees in the same company, individuals below or above a certain professional level, individuals working in a certain function, personality types, etc.,)?

6. How long have you been working in cable/telecomm?

7. What is your experience level?

8. Is there anything else you would like to add that you have not been asked?

Please complete this application, and email it to mentoring@wictrm.org. Applications must be received by September 27th, 2006. The mentors will assist with the matching process and participation and mentoring team assignments will be communicated by Oct 4th. Initial training and program kickoff is scheduled for October 26th, 8am – 5pm (location TBD).

It is recommended, though not required, that you obtain your employer’s support for your participation in this program and that you fully understand any limitations your supervisor may have on mentor assignment.

Program Cost

The cost of this program is will cost $375.00 – member; $455.00 – non-member (payable to WICT upon mentor assignment).

Please include payment information below. Only those who are accepted into the program (given space constraints) will be charged.

Amount Paid: ________________

WICT Member

Non-member

Charge To:

MasterCard

Visa

American Express

Direct Bill

Card Nnumber:		Exp. Date:
Card Holders Name:

Please feel free to contact any of the individuals listed below with questions or comments:

Contact Information

Please contact any of the following individuals for further information.

Lane Hammond – Fall ‘06 Co-chair lanehammond@zzyzks.com (303) 688-2546 home	Marti Moore – Fall ‘06 Co-chair Level3 Communications, Inc. Marti.moore@level3.com (720) 888-2323 office (303) 261-6065 cell
Shannon Saviers WICT-RM Mentoring Chair GrowthLinx, Inc. ssaviers@growthlinxinc.com (303) 814-1117	Susan Baker – WICT-RM Mentoring Co-chair Introspect International susan.baker@introspectintl.com (303) 942-9610 office

Thank you for participating in the personal development program.
We are looking forward to working with you.

Mentee Participation Checklist

Review the mentor profiles.
Review the program overview with your supervisor.
Complete the attached application, including payment information.
Submit the completed application to: mentoring@wictrm.org
Applications must be returned by 09/27/06. Assignments will be made on the basis of developmental interests and mentor/mentee preferences on a first come, first served basis. It is recommended that you get your material in as soon as possible.

Participants will be notified of their participation and informed of training program logistics by October 4th, 2006.

WICT – Rocky Mountain Chapter P.O. Box 21261 Denver, CO 80221