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Name
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Phone Number
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Email
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Company
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Years in Industry:
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Primary responsibilities
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Desired skills to develop (check all the apply):
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Client empathy / engagement
Adaptability to change
Collaboration
Developing / managing others
Thought leadership and innovation
Technical / analytical execution
Business writing skills
Presentation / public speaking
Juggling parenting and the workplace
Networking
Organization / time management
Stress management
Problem solving
Tough decision-making
Project management
Business / financial acumen
Other
If you chose "Other", please specify:
Your Career Goals - Short-term (1-3 years):
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Your Career Goals - Long-term (3+ years):
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What you are hoping to achieve through a mentoring relationship:
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