Providence College - President's Council Executive Mentor Program

	MENTOR PROFILE
Please use the tab key to navigate between fields; pressing enter will submit your form.
If you have any questions, please contact Stacey Moulton at 401.865.2958
or Kathy Clarkin at 401.865.2673.



	Career & Internship Services

PROFESSIONAL INFORMATION


NAME:
TITLE:
ORGANIZATION:
INDUSTRY:
ADDRESS:
CITY:
STATE:
ZIP:
EMAIL:
PHONE:
PREFERRED CONTACT METHOD:	Email Phone
WOULD YOU LIKE US TO COPY YOUR ASSISTANT ON ALL EMAILS?	Yes No

ASSISTANT'S NAME
TITLE:
EMAIL:
PHONE:

EDUCATIONAL INFORMATION

UNDERGRADUATE SCHOOL:
UNDERGRADUATE DEGREE/MAJOR:
GRADUATE SCHOOL:
GRADUATE DEGREE/MAJOR:

THE INFORMATION YOU PROVIDE IN THE FOLLOWING SECTIONS IS IMPORTANT IN THAT IT WILL: PROVIDE STUDENTS WITH A COMPREHENSIVE UNDERSTANDING OF YOUR ROLE IN YOUR ORGANIZATION. ASSIST THE OFFICE OF CAREER SERVICES IN MATCHING THE MENTOR WITH A MENTEE THAT FITS THE MENTOR’S CAREER AND THE MENTEE’S CAREER GOALS.

CAREER & MENTORSHIP INFORMATION

DESCRIBE YOUR ORGANIZATION AND THE WORK THAT YOU DO IN YOUR ROLE. PLEASE INCLUDE ANY SPECIFICS THAT MIGHT ASSIST STUDENTS IN DETERMINING THE FIT OF THIS OPPORTUNITY TO THEIR INTERESTS.

WHAT, IF ANY, PREFERENCES DO YOU HAVE REGARDING YOUR POTENTIAL MENTEE? (MAJOR, CAREER INTERESTS, SKILLS, EXPERIENCES, ETC.):

ADDITIONAL INFORMATION

(PAST EXPERIENCE/AREAS OF EXPERTISE, PROFESSIONAL INVOLVEMENT/DEVELOPMENT, SPECIAL INTERESTS, ETC.)

Thank you. We look forward to your participation.