BICSI Mentor Application Form

Mentorship Program – 2023/2024

Mentor Application Form

Thank you for your interest in the Mentorship Program. Please complete the form in its entirety. Note all questions require a response to successfully submit the application.

Name:

Phone Number:

Email:

Address:

Current Company and Position:

How long have you been in the ICT industry?

Are you currently a BICSI member (must be a current BICSI member to be an Mentor)? Yes No

BICSI member #:

What time zone are you in?

Do you hold any credentials? If yes, please list.

Please describe your ICT career to help us with pairing (Job roles, how you got involved in the industry):

Why are you interested in participating in the BICSI Mentorship Program?

Are you willing and able to dedicate yourself to a 1-year Program that will include, at minimum, a 1-hour Mentor/Mentee call per month. Conference attendance suggested, but not mandatory. Yes No

Are you willing and able to provide detailed feedback including learning experiences, outcomes, suggestions and assessment of Mentee at conclusion of program? Yes No

Please use this space for any additional comments.

Printed Name

Date

Note: The code is case sensitive.