In-person, when feasible

Experience2Exchange Application | MenteeFirst name: Last name:

Company name: Title:

Email: City/state:

List titles & names of last 3 companies you have worked for:

Education & degree(s):

I have previously been a mentee: Yes No

I am interested in becoming a mentee for the following reasons (check all that apply):

I am seeking career development and goal advice I am seeking advanced education or training advice

I am seeking con�dential job change advice I am seeking advice on how to develop and leverage networks in the industry

I feel stagnant in my career or in my position and I don’t know how to change it

I want help navigating the industry and developing professionally through industry engagement (e.g., becom-ing a moderator, publishing, presenting, leading)

I am seeking advice on how to better position myself in the industry, my company, school, etc.

I have general questions that arise from time to time

I am able and willing to participate as a mentee in the following ways (check all that apply):

By phone appointment By phone as needed

By emailVia video conference

I am excited to become a mentee because:

My one concern about becoming a mentee is:

Please return application to the AESP booth (#303) or scan and email this form to claudia@aesp.org.

My ideal mentor should have the following qualities (list 1-3):

Year you started in the industry: I want a mentor who is local: Yes No