EmailMeForm
DEI Mentorship Application
DEI Mentor Application
Name
First
Last
Email
Phone
###
-
###
-
####
Employer:
Title:
City and State
Years of Experience:
LinkedIn/Social Media
Age Range:
<25
25-34
35-44
45-54
55-64
65+
My pronouns are:
Areas of interest in DEI
Neurodiversity/Ableism (serving clients with disabilities or identifying as an individual with disabilities)
LGBTQIA+
Gender Identity
Asian/Pacific Islander
Black/African American
Latino/Latina/Latinae/Latinx
Native American
Ageism
Religious Affiliation
Political Affiliation
Other
Please select all areas that apply to you or that you are open sharing you experiences about.
Photo
Have you previously been a mentor/mentee?
Yes
No
If yes, please describe:
Preferred communication:
Phone
Email
Text
Virtual Meeting
Most Desirable Time of Day:
Mornings
Afternoon
Evenings
How do you spend your time outside of work? Please share hobbies, interests, volunteer work charitable activities, community, or other pursuits.
Which of the following describes you the best?
Career Changer
Young Superstar
Solo Business Owner
Large Firm Employee Advisor
Evaluate the following statements.
Not at all important
Slightly Important
Fairly Important
Most Important
N/A
Positioning myself for career advancement or career transition
Expanding my professional network
Advice on leadership skills and how to get promoted
Help with specific challenges in my current position (such as resolving conflicts, accessing career-relevant resources, working in a male-dominated environment/industry, building relationships inside and outside my company)
Disability Bias in the Workplace
Obtaining introductions to specific people in my industry or profession
Encouragement and guidance related to life and career (help with work-life balance and setting boundaries)
New opportunities
Political or geographic bias in the workplace
Income and compensation
Gender bias in the workplace
Mental health in the workplace
What is your ultimate business/professional aspiration?
Please list up to four topics for discussion that would be of particular interest to you?
How have you been involved with the NAPFA DEI Initiative?
I have been a participant in a NAPFA DEI Initiative conversation circle.
I am a member of the NAPFA DEI Community Forum Facebook group.
I have attended a NAPFA DEI Initiative conference networking event.
I have not previously been involved in the NAPFA DEI Initiative.
Can you meet the program requirements of meeting at least once per month from May to October?
Yes
No
Do you plan to attend the NAPFA Spring 2023 National Conference in San Diego on May 8 - 10?
Yes
No
Unsure
Do you plan to attend the NAPFA Fall 2023 National Conference in Louisville on October 18-21?
Yes
No
Unsure
Would you be interested in being a [mentor/mentee] liaison to the Mentorship Committee?
Yes
No
