Mentoring Circles - Mentee Application

The Central Exchange mentoring circle program is expanding! We are pleased to offer this highly valuable benefit to our members and hope you'll participate! This form should be completed in its entirety for those wanting to be considered for the 2018 mentoring circles. Applications will be accepted through January 12th and new circles will begin at the end of January or early February. Applicant submissions received after January 12th will be matched to an existing group. Only Central Exchange members may participate in this program.

Name

Title

First Name *

Last Name *

Suffix

Email *

What is your email address?

Please select your location preference

Downtown (KCMO) South (Overland Park) I am able to go to either location

We will do our best to match you with a circle that meets your location desire however this can not be guaranteed

LinkedIn Profile *

Please include your LinkedIn URL

Employer *

Please list the name of the company you work for or own

Job Function *

What is your current job function?

Job Title *

What is your current job title?

Personal Strengths *

What are your greatest strengths?

Priorities *

What are the top three priorities you would like to achieve in your mentee/mentor relationship?

Challenges *

What are a couple of the major challenges you are experiencing and trying to overcome at the moment?

Success *

At the end of the twelve month mentor cycle, what will success look like in your eyes?

Mentorship *

What does mentorship mean to you?

Committment

1-5 6-10 10+

How many times a year can you commit to meeting with your circle?