Mentee Registration - PHI CHI THETA

Mentee (Collegiate) Registration

Registration Opens – 9/30

Registration Closes – 10/11

Week 1 & Match Emails – 10/21

Week 2 – 10/28

Week 3 – 11/4

Week 4 – 11/11

Week 5 & Survey – 11/18

PLEASE NOTE: Match information will be sent out on October 21 along with the first week assignment.

First Name*

Last Name*

Email*

Phone*

City*

State*

Zip*

School*

Graduation Date*

Major*

Chapter Name*

My Gender is:*

Additional Majors or Minors

Fields and/or Industries of Interest*

Resume*

Do you want a Mentor if there is not one available in your areas of interest?*

Yes No

Have you participated in past PCT Mentoring Programs?*

First Time Past Participant

Best Days/Times of Availabilty*

Additional Information to Assist Matching

Please list your goals for this program*

Agreement Statement*

I UNDERSTAND THAT BY REGISTERING AS A PARTICIPANT IN THE NATIONAL MENTORING PROGRAM, I AGREE TO HAVE MY INFORMATION SHARED WITH A MATCH FOR THE PURPOSES OF THE PROGRAM.

Agreement Statement*

I UNDERSTAND THIS IS A FIVE WEEK INTERACTIVE PROGRAM AND PARTICIPATION IS REQUIRED. I AGREE TO DEDICATE A MINIMUM OF ONE HOUR PER WEEK DURING THE COURSE OF THE PROGRAM.

Agreement Statement*

IF I AM UNABLE TO PARTICIPATE AT ANY TIME, I WILL USE PROFESSIONAL ETIQUETTE AND I WILL NOTIFY MY MATCH AND PROGRAM COORDINATORS IMMEDIATELY. FAILURE TO DO SO WILL RESULT IN FUTURE NATIONAL PROGRAM RESTRICTIONS.