ISACA Internationals Pilot Mentoring Program

Mentee Application
This application provides the basis for making appropriate matches for mentors and mentees. The more detailed
information you provide, the better your match is likely to be. Please use additional pages if necessary.
When finished, send your completed form to yps@isaca.org by 15 April 2014.
Contact Information
Name
[Click to type name]
ISACA Member Number
[Click to type member number]
City
[Click to type city]
State
[Click to type state]
Country
[Click to type country]
Phone (include all necessary prefixes)
Work
[Click to type work phone]
Other (home/mobile)
[Click to type other phone]
Skype/Other IM screen names
[Click to type Skype/other screen names]
(please provide platform)
Email
[Click to type email]
Company
[Click to type company name]
Title
[Click to type Title]
Preferred Method of Contact
[Click to type preferred contact method]
Background Information
1. With which ISACA chapter are you affiliated? [Click to type response]
2. Professional Degrees, Distinctions, Awards (CISA, CISM, CISSP, CIA, CFSA, etc.): [Click to type response]
3. Number of years in the profession: [Click to type response]
4. Number of years in the IT Governance Profession (if applicable): [Click to type response]
5. Universities attended (including graduate schools): [Click to type response]
6. Have you ever before been mentored? If so, please explain: [Click to type response]
7. Please indicate (with an X) your level of interest and expertise in the following areas:
Novice

Working Knowledge

Expert

Project Management
IS Audit Process
IT Governance
Systems and
Infrastructure Life
Cycle Management
IT Service Delivery &
Support
Protection of
Information Assets
Business Continuity
and Disaster Recovery
Human Resources
Risk
Procurement
Quality
Internet/Ecommerce

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ISACA Internationals Pilot Mentoring Program

Mentee Application
Portfolio Management
Conflict Resolution
Negotiation Skills
Other (Please specify):

8. Industry in which you currently work: [Click to type response]

9. Other industries in which you have experience: [Click to type response]
10. Interests/Hobbies (please elaborate as much as you can in this area as this qualitative data will assist
greatly in the matching process): [Click to type response]
Mentoring Information
1. Please provide an estimate of your availability to be mentored (e.g., hours per week, per month, etc.) [Click
to type response]
2. Are you available to meet in person? If so, in what city, state, etc.? [Click to type response]
3. What is your preferred language for a mentoring relationship? [Click to type response]
4. Please describe your working style. For example, do you work best in a structured/unstructured,
hierarchical, collaborative, etc. environment? [Click to type response]
5. Have you participated in a structured mentoring program and/or worked with a mentor/mentee in the past? If
so, please describe: [Click to type response]
6. What is motivating you to seek a mentor at this time? [Click to type response]
7. Please provide a summary of your goals for working with a mentor. [Click to type response]
8. On what skills would you like to focus/improve? [Click to type response]
9. Are you currently participating in any other ISACA programs - local mentoring activities, academic liaison
work, industry outreach positions, and local exam review/prep course involvement? If so, please explain.
[Click to type response]
10. Is there any additional information you would like to share? [Click to type response]
11. Please attach a current resume or CV to your email when you submit your application.
Mentoring Program Minimum Expectations
By completing this application, I agree to:
Commit to a 1 year relationship with a mentor, meeting a minimum of once per month
Take responsibility for my own growth and development
Listen and learn from the mentoring relationship
Discuss, define, agree, and maintain the confidentiality of my mentoring relationship as agreed upon by both
mentee/mentor.
All conditions listed above must be agreed to in order to participate in this program. Please check all of the
above boxes prior to sending your application.

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