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3CMA Mentorship Program
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This form has been modified since it was saved. Please review all fields before submitting.
First Name
*
Last Name
*
Title
*
Jurisdiction
*
City
*
State
*
Email
*
LinkedIn URL
Work Phone
*
Cell Phone
Would you like to be a:
*
Mentor
Mentee
Both
Please describe your job duties:
*
Work Area
Please select each of the following in terms of your areas of expertise (for those who want to be mentors) and areas where you’d like to grow your skills (for those who want to be a mentee)
Strategic communication
One of my strengths
Looking for growth
Getting a seat at the leadership table
One of my strengths
Looking for growth
Writing a communication plan
One of my strengths
Looking for growth
Writing a crisis communication plan
One of my strengths
Looking for growth
Effectively utilizing social media
One of my strengths
Looking for growth
Social media advertising
One of my strengths
Looking for growth
Using video for effective communication
One of my strengths
Looking for growth
Video production
One of my strengths
Looking for growth
Website development/management
One of my strengths
Looking for growth
Communicating with elected leaders
One of my strengths
Looking for growth
Internal employee communication
One of my strengths
Looking for growth
Newsletters/calendars/citizen publications
One of my strengths
Looking for growth
Reaching diverse communities
One of my strengths
Looking for growth
Relationship with supervisors
One of my strengths
Looking for growth
Community events
One of my strengths
Looking for growth
Large-scale community projects
One of my strengths
Looking for growth
Community planning
One of my strengths
Looking for growth
Building community trust
One of my strengths
Looking for growth
Workload/stress management
One of my strengths
Looking for growth
Managing challenging employees
One of my strengths
Looking for growth
Developing a productive team
One of my strengths
Looking for growth
Professional growth
One of my strengths
Looking for growth
Other strengths (as a mentor)
Other areas where I’d like to grow (as a mentee)
What is the #1 thing you’d like to get out of being a mentor (if applicable)
What is the #1 thing you’d like to get out of being a mentee (if applicable)
What are three things you like to do outside of work that bring you joy
3CMA Mentorship Program Code of Ethics
*
Participants in the 3CMA Mentorship Program agree to:
Treat others within the Mentorship Program with respect.
Protect the confidentiality of information shared.
Not accept any fees or commissions.
Be honest and accountable in all interactions.
Recognize the diversity of the Mentorship Program and respect the variety of cultural norms, beliefs, practices, and values it contains.
Assist with ideas, feedback, strategies, and support that further the opportunity for citizen engagement, involvement, and interaction that is authentic and a positive representation for local government.
I commit to meet with my mentor/mentee at least once a month and to following the ethical guidelines put forth with this application.
I Agree
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