Resources

Name *

First Name

Last Name

Event Date *

MM

DD

YYYY

Question & Answer Session? *

Yes

No

Name *

First Name

Last Name

Phone *

(###)

###

####

Would you be willing to participate in small-group mentorship sessions (2-3 mentees per mentor)?

Yes

No

Are you able to meet for a one-hour mentorship session once every 6-8 weeks for 1 year? *

Yes

No

Would you be willing to commit to a structured program with defined goals to achieve over the course of that year? *

Yes

No

What is your preferred method of communication to coordinate those meetings?

E-Mail

WhatsApp

Text

Phone

Do you prefer virtual or in-person mentorship sessions? *

Virtual

In-Person

Hybrid

Name *

First Name

Last Name

Phone *

(###)

###

####

Have you served as a mentor before?

Yes

No

Do you prefer one-on-one mentorship or would you be willing to participate in small-group mentorship sessions (2-3 mentees at a time)? *

I prefer one-on-one mentorship

I prefer small-group mentorship

Are you able to meet for a one-hour mentorship session once every 6-8 weeks for 1 year?

Yes

No

Would you be willing to work with the Mosaic Mentorship Director to develop a structured mentorship program for the year (i.e. identify key objectives and milestones to reach them)?

Yes

No

What is your preferred method of communication to coordinate those meetings?

E-Mail

WhatsApp

Text

Phone

Do you prefer virtual or in-person mentorship sessions?

Virtual

In-Person

Hybrid