GPACAC Mentorship Program Registration

First Name*

Preferred Name

Last Name*

Pronouns

Title*

Email Address*

Phone*

Employer*
(Please choose from the autosuggest options - don't see yours? Email membership@gpacac.net)

Years of experience in the college counseling and/or admissions profession:*

Years of experience in your current role:*

If your experience in the profession exceeds your experience in your current role, please share a brief description of your work history:

I am a(n):*

I am applying to be a:*

What are you hoping to gain as a part of the mentorship program (100 words or less)?*

I feel most comfortable being paired a mentee that works in the following area(s) (check all that apply):*

Would you be willing to and have capacity to mentor two individuals? Please note we would ask that you meet with your mentees separately.*

I would value a mentor that works in the following area(s) (check all that apply):*

To help us get to know you better, please share a brief bio about yourself that includes personal interest, hobbies, family, or more that would help facilitate a best match. (100 words or less)*

Reflect on where you are and where you wish to be. Are there any areas you hope to grow in or learn more about?*

Is there anything else you wish for us to know about helping find your best match?