Mentorship Program Application

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Date of submission:	Today
Name:
Job title:
Current employer:
Relevant past employers:
Education:
Phone number 1:	( ) - Second three digits Last four digits
Phone number 2:	( ) - Second three digits Last four digits
Email:	Please provide your personal email address
Secondary Email:
# years of public relations experience:
I am a CPRS member :	Yes No
Are you interested in being a Mentor or a Mentee:	Mentor Mentee
Are you accredited:	APR IABC Other (e.g. Marketing)
If "Other", please list:
What areas or skill sets are you interested in learning more about? (Choose all that apply):	Management/administration Community relations/engagement Issues or crisis management Government relations Writing/editing Consulting Social media Employee/internal communications Media relations Publicity Accreditation support Marketing integration Other:
If "Other", please describe:
Which sector(s) are you interested in learning more about? (Choose all that apply):	Government Non-profit/charity Consultant Agency Education Health Finance Industry/manufacturing Tourism/hospitality Utility sector Other:
If "Other", please describe:
What geographical areas are convenient for meetings with your mentor/mentee?:	Vancouver North Shore South of the Fraser (Delta, Surrey, Langley) Richmond Burnaby/New Westminster Coquitlam Pitt Meadows/Maple Ridge
Tell us a bit about you and why you are interested in being a mentor or a mentee. Perhaps explain potential impacts on your career, gaps in your experience you would like to work on: