Apply to be a Mentor

The information that you provide will be kept confidential and will only be used to pair you with an Candidate who best matches your background and experience.

Mentor Volunteer
Name:
Member No:
Position/Title:
Company:
Contact Information:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Phone:
Email:
Business Type:
Consulting Government Laboratory
Construction Health Care Manufacturing
Education Insurance Service
Other        
If you chose "other" business type...
Please Specify:
Education:
Previous Work Experience (Companies & Positions):
Do you have any Professional Certifications?
CSP CIH CHMM
PE Other    
If you chose "other" Professional Certification(s):
Please Specify:
Thank you for your interest in the Mentoring Program! We have added a simple tool to prevent spam attacks on our signup page. Please think back to the higher math that you learned in grade school and complete the math challenge before proceeding. Add the two numbers that appear and type your answer in the box provided.
MathGuard security question, please solve:

KHM         SQ3      
Q      L    S M   25T
3TS   O3C   U2P      
  A    9    R 2   CFA
FQ3         M1T

 

Chapter Contacts

For more information about the ASSE Northwest Chapter, please contact:

Chapter President
William R. "Bill" Stuart
Phone: 612-671-8431

Website Editor
Richard "Rick" Johnson
Phone: 763-551-1022