Harvard College Women's Center

* Name:

* Class Year:

Previous experience: Is this your first year participating?
Yes No

If no, have you and your mentee made arrangements to continue as a match this year?
Yes No

If yes, please give her/his name and class:

* Home Address:

* Telephone (home):

* Work Address:

Telephone (other):

* Email Address:

May we contact you at this e-mail address?
(updates, event reminders, etc)
Yes No

Children: Some mentees are interested in work/life balance strategies for women with children. Do you have children?
Yes No