Mentorship Program Application Spring 2024 Name * Last * Gender * MaleFemaleNon-binaryNo genderPrefer not to say Pronouns * She/Her/HersHe/Him/HisThey/They/TheirsPrefer not to say Title * Company * Email * Cell Phone * State of Current Residency * AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashington (State)Washington, D.C.West VirginiaWisconsinWyoming I’m Interested in * Being mentored (I have 1-5 years experience)Being mentored (I have 6-10 years experience)Being mentored (I have 10+ years experience)Mentoring (I have less than 10 years experience)Mentoring (I have 10+ years experience)Mentoring (I have 20+ years experience) Topics I’m interested in mentoring/being mentored on (select all that apply) * Management Leadership Interviewing Skills Career Trajectory Public Speaking Business Development/Sales Customer Service Claims Adjudication Litigation Underwriting Data & Analytics Finance Human Resources Diversity & Inclusion Continuing Education Actuarial Skills Marketing Design Thinking Innovation IT and Technology Other (not listed above) I prefer to be paired with a * MaleFemaleNon-binaryDoes not matter If you are human, leave this field blank. Submit Δ
