Mentor 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

First Name*

Last Name*

Email*

Phone*

City*

State*

Zip*

School*

Graduation*

Major*

Chapter Name*

Additional Majors or Minors

Employer*

Position*

Field and/or Industry of experience*

PCT Mentor Experience*

First Time Past Participant

How Many Mentees?*

Just One I'm Feeling Ambitious

Best Availabilty*

Additional Information to Assist Matching

Agreement Statement*

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