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Disability Mentoring Day

Mentee Application

Are you an energetic and enthusiastic student or job seeker with a disability looking for a workplace mentor?

Then, taking part in Disability Mentoring Day, is for you! DMD enables students and job seekers to spend part of a day visiting a business, a non-profit agency, or government agency that matches their interests and have one-on-one time with volunteer Workplace Mentors.

Each year, Disability Mentoring Day (DMD) is observed on a Wednesday in October, in conjunction with National Disability Employment Awareness Month. This year DMD is scheduled on October 29, 2008 in Buffalo. However the actual mentoring experience can happen anytime in October. Or anytime during the year that is fits the schedule of the Mentor & Mentee.

Deadline: All applications must be received at least 4 weeks before the scheduled mentoring experience.

Please provide the following contact information:

Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Home Phone

FAX

E-mail

Choose one of the following educational options:

Name of school you are attending?

What is your major area of interest?

Highest level of education attained. Choose ones:

Please provide the following School or professional contact information (Teacher, Counselor, Professor, or Service Provider:

Name

Title

Organization

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Work Phone

E-mail

Select up to three or more career choices:

Arts and Communication
Business and Marketing
Education
Food, Recreation, and Hospitality
Health and Medicine
Human Services
Law, Government, and Public policy
Law Enforcement
Natural Resources, Environment and Agriculture
Technology, Engineering and Science
Other

Please indicate your most important career choice listed above?

When can you participate in a mentoring experience?

Dates that I am available for mentoring:

Reasonable accommodation request. Select any of the following options that apply:

Braille
computer disk
Large print
Wheelchair access
Sign Language interpreter
Dietary needs

Please describe your specific accommodation needs?

What is your long-term career goal ?

Describe your paid and/or unpaid work experience (if any) ?

Describe the job-related skills that you have (if any). If not, what skills do you hope to gain?

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Home Phone
FAX
E-mail