FPDA Mentoring Program: Mentee Participation Form

FPDA Mentoring Program: Mentee Participation Form

Please complete the following:

Find me a mentor.
I have a mentor in mind.
Desired Mentor:
Desired Age of Mentor:
Desired Gender of Mentor:
I am interested in participating, but would like to discuss the program in more detail before getting started.
Name:
Title:
Company Name:
Company Address:
City:
State/Province: Zip/Postal Code:
Country:
Work Telephone:
Cell Phone:
Email:
Birthday:

Company Information:

Sales Category:
Company Type:
Number of Employees:
Products Distributed or Manufactured:
Main Product Brands (Distributors):
Area or Territory Covered:
What are some key business challenges your company is currently facing?

Personal Information:

Please give a brief description of your career:
Describe your current responsibilities:
Please list your key business skills and strengths:
What are some of your person interests or hobbies?
Are there particular topics or skills areas on which you would like your mentor to focus?

Social Media Profiles:

Twitter:
Facebook:
Linkedin:
Instagram: