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APPLICATION MENTOR APPLICATION
Language Preference / Préférence linguistique
*
English / anglais
French / français
Name
*
First Name
*
Last Name
*
Phone
*
Email
*
PPOC Titles
CPA
MPA
SPA
F/PPOC
How many years have you been a member of the PPOC?
*
3 - 5
6 - 10
11 - 15
15 +
What type(s) of photography do you specialize in?
What accreditations do you have?
*
Which branch/region are you a part of?
PPOC BC
PPOC AB
PPOC SK
PPOC MB
PPOC ON
PPOC QC
PPOC ATL
PPOC BC
Lower Mainland
Island
Interior
Northern
PPOC AB
South
Central
North
PPOC ON
Northwestern Ontario
Central Ontario
Western Ontario
Eastern Ontario
North Eastern Ontario
Hamilton Niagara
Do you have a specific protege you wish to be paired with?
Yes
No
Avez-vous un protégé spécifique avec lequel vous souhaitez être jumelé?
Oui
Non
Name of preferred protegé
First Name
Last Name
nom du protégé préféré
First Name
Last Name
Would you like your protege to be from your branch/region?
Yes
No
No preference
What are your strengths that would make you a good mentor?
What level of contact are you able to offer to your protégé?
Weekly
Bi-Weekly
Monthly
How many individuals are you interested or able to mentor at once (max 3)?
1
2
3
Signature
*
[clear]
Use your mouse or finger to draw your signature above
Nom
*
Prénom
*
Nom
*
Téléphone
*
Courriel
*
Titres (PPOC)
CPA
MPA
SPA
F/PPOC
Vous êtes membre des PPOC depuis combien d'années?
3 - 5
6 - 10
11 - 15
15 +
Vous vous spécialisez dans quel (s) type (s) de photographie?
Quelles accréditations avez-vous?
De quelle branche / région faites-vous partie?
PPOC BC
PPOC AB
PPOC SK
PPOC MB
PPOC ON
PPOC QC
PPOC ATL
Souhaitez-vous que votre protégé provienne de votre branche / région?
oui
non
Souhaitez-vous que votre protégé provienne de votre branche / région?
Quels points forts feront de vous un bon mentor?
Combien de personnes êtes-vous intéressé(e) ou en mesure de mentorer en même temps (max 3)?
1
2
3
Quel niveau de contact pouvez-vous offrir à votre protégé?
Hebdomadaire
Bi-hebdomadaire
Mensuel
Signature
*
[clear]
Use your mouse or finger to draw your signature above
Internal Use Only
Mentorship Chair Reviewed
Mentor / Protege Matched
Name of Protege
Commencement Date of Mentorship
Protege Review Received
Yes
No
Number of Merits Approved
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