Mentorship Participant FormWhat mentorship program are you participating in? Professional Mentorship Rural Mentorship I consent to be added to the 2024/25 Professional Mentorship contact list, to be distributed to the participants for connecting purposes Yes No Your Name (Full name you wish to go by professionally, and when credited publicly)(Required) Which mentee/mentor are you working with in your mentorship program?(Required) Email(Required)Your email will not be made publicly available or used in any of the content created for the website, newsletter, or social media. Phone(Required)Your phone number will not be made publicly available or used in any of the content created for the website, newsletter, or social media. Website Social Media Channels Pronouns AccessibilityPlease let us know of any of your access needs. This could be accessibility or mental health related, anything you would like to share so we can better support you. Dietary Needs (if applicable)Please list any food restrictions or allergies
