Mentor Registration of Interest form
Name
Address
Work phone
After hours phone
PMI membership number
PMP ID# Year gained Expiry date
Other qualifications
Years of experience in project management
What are your reasons for wanting to be a mentor?
What skills do you have that you consider suitable for a mentor?
When are you available to provide mentoring?
- Normal work hours
- Evenings. Which nights/times?
- Weekend. Which days/times?
- Only on the following specific days/times
Where would you be happy to provide the mentoring?
- At your work (Please provide the address)
- At home
- At the mentee’s work
- At the mentee’s home
- Other (Please specify)
Please tell us additional comments / requests / preferences / restrictions that you would like considered.
I understand that in submitting this Registration of Interest that
- I am not obligated to take any particular assignment
- I am not yet accepted as a Mentor
Signed
Date
A mentee may require a mentor that matches their industry and or occupation. Please place an X next to the industry and/ or occupation experience you have.
Industry
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Construction
Commercial / Heavy / Industrial
Residential
Other
Manufacturing
Automotive
Chemical
Concrete / Clay / Glass / Stone
Electrical/Electronic
Food
Machinery/Metals
Paper
Petroleum
Pharmaceutical
Plastics
Textiles/Fabrics
Wood
Other
Other Business Activities
Academia
Aerospace
Architecture/Design
Arts / Entertainment / Broadcasting
Automation Systems
Business Mgmt Services
City Management
Computers / Software / DP
Consulting
Defence
E-Business
Economics/Finance
Education/Training
Engineering
Environmental / Waste / Sewage
Financial Services
Healthcare
Information Technology
International Development
Legal
Printing/Publishing
Public Administration
Public Health / Human / Social Services
Real Estate / Insurance
Recreation
Scheduling
Supply Chain
Systems Security
Telecommunications
Transportation
Urban Development
Utilities
Web Technology
Other
Resources
Agriculture
Coal/Gas/Oil
Ferrous Mining
Forestry
Non-Ferrous Mining
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Occupation
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Job Function (Engineering)
Chemical Engineering
Civil Engineering
Electrical Engineering
Electronics Engineering
Environmental Engineering
Industrial Engineering
Mechanical Engineering
Other Engineering
Job Function (Management)
Communications Management
Configuration
Contract/Procurement Mgmt
Corporate/Administrative Mgmt
Cost Management
Critical Chain
Earned Value
Human Resources Management
Information/Computer Management
Materials Management
Project/Program Manager
Quality Management
Records Management
Risk/Safety Management
Scope/Technical Management
Site/Facility Management
Time Mgmt/Scheduling/Planning
Job Function (Other)
Consulting
Distribution
Finance
Financial Services
Legal
Marketing/Business Devmt/Sales
Production
Project Accounting/Audit
Public Relations
Research/Product Development
Service and Outsourcing
Teaching/Training
Web Strategist/Technologist
Other
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