PMINYC Mentoring Program

Application for Mentees

The following application provides the basis for making appropriate pairings between Mentors and Mentees. The more detailed information provided, the better able the Program Manager is to match you with a partner. Please use additional pages as necessary.

Send the completed form to .

Contact Information

Name:
Address:
City: / State: / ZIP:
Work Phone: / Home
Phone: / Email:
Preferred method of contact:

Background Information

  1. PMI NYC Member Number (this program is only open to members):______
  1. Are you a PMP? ______
  1. If yes, number of years as a PMP: ______
  1. Number of years in the profession: ______
  1. Community of Practices (CoP) Memberships? (Please list): ______

______

  1. Any memberships with other PMI Chapter(s) (Please list): ______

______

  1. Present industry in which you work:______
  1. Other industries in which you have experience: ______
  1. Professional Degrees, Distinctions, Awards: ______

______

  1. Interests/Hobbies:______
  1. Please indicate your interest and expertise in the following areas:

Novice / Working Knowledge / Expert
Scope
Time
Communication
Cost
Human Resources
Risk
Integration
Procurement
Quality
PMO/PO
IT Systems
Internet/Ecommerce
Portfolio Management
Conflict Resolution
Negotiation Skills

Mentoring Information

  1. Please describe your working style. Do you work best in a structured, unstructured, hierarchical,

collaborative, etc. environment? ______

  1. In terms of duration, how many consecutive months can you commit to the program? ______
  1. If you are available to meet in person, what area is best for you (Manhattan, Westchester, etc.)?

______

  1. Have you participated in a structured mentoring program (in your workplace, for example)? If so,

describe… ______

______

______

  1. What is motivating you to seek a Mentorat this time? ______

______

______

  1. Please provide a summary of your goals for working with a Mentor: ______

______

______

  1. What project management skills would you like to focus on? ______

______

  1. Are you currently participating in any other PMINYC programs? If so, please list: ______

______

  1. Is there any additional information you would like to share in processing your application?

______

______

______

All PMI credential holders participating in the Mentoring program self-report earned PDUs. Mentors and mentees can earn 1 PDU per hour of participation, claiming up to a maximum of 8 PDUs annually and up to 25 PDUs over a 3-year period.

PMP Mentees enter earned PDUs in the “Self-Directed Learning Worksheet” in the Activities Reporting Form on the PMI website.

By entering into the Mentoring Program, participants agree that neither PMI, the New York City Chapter of PMI, nor any other participants have any liability for the suggestions and/or advice provided to them during the mentoring relationship.

______

Name

______

Signature

______

Date

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