Mentor Program Information Form

Note: Please complete the following information which will be used to help us to make appropriate matches.

Name:
Affiliation with Drury (check one)
Alumnus
Current Parent
Friend
Past Parent
Trustee
Other

(If other, please specify)
Preferred Mailing Address
Preferred City
Preferred State
Preferred Zip
Preferred Telephone
Email
Organization Name
Title/Position
Which of the following best describes your professional interest or industry? (Check all that apply)
Accounting
Advertising
Banking
Communications
Economics
Entertainment/Sports
Information Technology
Finance
Health Care
Human Resources
Management
Marketing
Market Research
Other
(If other, please specify)
How many years of experience do you have in this profession or industry?
None
1 to 3 years
4 or more years
Would you prefer to be matched with a mentee who is:
Male
Female
Either male or female would be fine
Are you able to allot at least 10 hours over an approximate 10 month period:
Yes
No
Unsure
Please add a brief bio to ensure the best match:
Do you have any other preferences or interests that would help us make a good match?