Clark University/Worcester Professional Application Program
Mentor Profile

Professional Information
First Name  Last Name  
 
Title  

Organization  Industry  

Address
Street City/Town State  Zip


Email

Phone     Alternate Phone    

Preferred Contact Method? Email Phone
Would you like us to copy your assistant on all emails? Yes No
Name Title

Email Phone    

Education Information
Undergraduate School  Graduate School  

Undergraduate Degree/Major  Graduate Degree/Major  
 

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.