Apply to Become a Mentee

Mentee Profile

Name*

Job Title*

Brief description of job responsibilities*

Company Name*

Company Location*

Type of Company*

Phone*

Email*

LinkedIn Profile

Preferred Method of Contact*

Email
Phone
Text

Industry Experience

Years of Captive Insurance Experience

Select All That Apply*

Other*

Education

College or University Attended*

Major and/or Degrees*

Professional Certifications and/or Memberships Held*

Mentorship

Do you have previous mentorship experience?*

Yes
No

Describe what you hope to achieve by being mentored in a few sentences*

By checking this box I, a mentee in the CICA Mentorship Program, agree to the following confidentiality statement:*

I shall not, except as authorized by my assigned mentor(s), at any time during or after our participation in the CICA Mentorship Program disclose to any other person or entity any proprietary, confidential, or sensitive information of or pertaining to them (collectively called “Confidential Information”), which has to come into my knowledge during the course of the mentoring and other program activities. I will not disclose or use, directly or indirectly, any Confidential Information, or make such Confidential Information available to others for use in any way. This does not preclude me from providing feedback on the structure of the Mentorship Program and my experience participating in it to CICA in order for CICA to improve the program for future participants. I agree to complete periodic surveys to help CICA improve the program.

I agree

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Membership Pays

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Apply to Become a Mentee

Mentee Profile

Industry Experience

Education

Mentorship