One+One Mentor Membership Form ACCOUNT INFORMATION (For isisHawaii Use Only.  Except for Display Name) User Name: Display Name: Full Name: Address: City: State: Zip Code: Phone: Fax: E-mail: It's ok to send me email. (isisHawaii related notices, eNews, etc.)  View our privacy policy. Password:   (Passwords ARE case sensitive.) Confirm Password: How did you find us? 2005-6 One+One Program 2005-6 McKinley Engineering Academy 2005-6 Roosevelt Engineering/Tech Academy School Counselor/Instructor Friend isisHawaii One+One Activity 2005-6 SWE Internet 2004-5 One+One Program WIT/Mililani High School Pilot Newspaper Flyer/Handout Radio Parent Other NOTE: Fields in RED are REQUIRED fields. ONE+ONE INFORMATION What is One+One? The following information will help us create our teams.  This information will not be displayed in your public profile.  If you are applying to the One+One Program, please be sure to complete the required fields (in blue) before submission. Mahalo. Brief Background:  (will be sent to team members) What do you want to gain from this program?: Program Requirements: I agree to: At least ONE email exchange/week Agree to submit evaluation upon completion Read Privacy/Conduct Policies MENTOR INFORMATION What is a One+One Mentor? The following information will help us create our teams.  This information will not be displayed in your public profile.  If you are applying to the One+One Program, please be sure to complete the required fields (in blue) before submission. Mahalo. What inspired your career choice? Who was your role model and how did he/she affect your life? Mentoring Experience: Current Interesting Projects: Would you be interested in? (Click all that apply): Guest Speaking On-site Visitations Job Shadowing Online Workshop Participation Offline Workshop Participation (not to exceed 1x/quarter) EDUCATIONAL AND PROFESSIONAL BACKGROUND: Please include a brief summary of your educational and professional background or cut and paste your CV (resume) here. Include three professional references and contact information. MEMBER PROFILE INFORMATION (This information will be publicly viewable.) Favorite Pastime(s): Fitness Travel Reading Handcrafts Cooking Volunteer Work Tennis Golf Paddling Sports Gourmet Food and Wine Family Fundraising Gardening Other Expertise: Picture File: (Note: File format must be a .gif or .jpg.  No larger than 240x120.) Share Space: Share you favorite quote or what you want to be when you "grow up" or anything else that you would like others to know about you.