YP Mentor Application - NEWEA - New England Water Environment Association

1. Name*
First Last
2. Company Name
3. Address*
Street Address Address Line 2 City State ZIP Code
4. Email*
5. Phone
6. Job Title
7. Which sector of the water/environment industry do you work?
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. Briefly state previous experience you may have had as a mentor. If this is not applicable, skip to the next question.
11. Are you associated with any other industry professional organizations aside from NEWEA? If so, please list
12. Are you a member of NEWEA?*
- Yes
- No
13. Will you be able to fulfill the program requirement of meeting once quarterly (every three months) with your mentee in person or over the phone?*
- Yes
- No
- I'm not sure
14. Please indicate how many years of water/wastewater industry experience you have.*
- 0-14 years
- 15-25 years
- More than 25 years
If not, how often will you be able to commit to meeting your mentee?
15. Please provide a brief biography of yourself (no more than 5-6 sentences) so we can more accurately place you with a suitable mentee.