Mentee Application 1. Name* First Last 2. Company Name3. Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 4. Email* 5. Phone6. Job Title7. Which sector of the water/environment industry do you work or are you interested in?8. Why do you wish to participate in the NEWEA Mentoring Program?9. What do you hope to gain from participating in the NEWEA Mentoring Program?10. Are you a member of NEWEA?* Yes No If no, are you associated with another industry professional organization?11. Will you be able to fulfill the program requirement of meeting once quarterly (every three months) with your mentor in person or over the phone?* Yes No I'm not sure If not, how often will you be able to commit to meeting your mentor in person?12. Please indicate how many years of water/wastewater industry experience you have.* 0-5 years 6-10 years More than 10 years 13. Please provide a brief biography of yourself (no more than 5-6 sentences) so we can more accurately place you with a suitable mentor. Δ
