Mentorship Program

• Name*
  First Last
• Email*
  Enter Email Confirm Email
• Phone*
• Applying As:*
  • Mentee
  • Mentor
• CALPCC Member*
  • Yes
  • No
• Are your related experiences and schooling out of state? If so, please describe:
• (For Mentor) What sector are you currently working in:
  • Agency
  • Private practice
  • University/Academia
  • School setting, please indicate below K-12, Community College, etc.
• What do you hope to gain from participating in the mentorship program?*
• What aspect of the mentorship program are you looking forward to most?*
• (For Mentees) What is the amount of time you expect your mentor to commit to participating in this program?*
  • 1 hour a week
  • 1 hour a month
  • Less than 1 hour a month
  • More than 1 hour a week
• (For Mentors) What is the amount of time you are able to commit to participating in this program?*
  • 1 hour a week
  • 1 hour a month
  • Less than 1 hour a month
  • More than 1 hour a week
• CALPCC Region*
  • San Francisco
  • East Bay
  • North Bay
  • Santa Clara
  • Sacramento
  • Fresno
  • North San Joaquin Valley Inland Empire
  • Los Angeles Orange County San Diego Santa Barbara