Name
First name: *required
Last name: *required
Mailing address
Street address:
City: *required
State: *required
Zip:
Contact info
Phone: *required
Alternate Phone(s):
E-mail (required): *required
Why do you want to be a mentee? *required
How many years have you worked professionally as an interpreter? none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
What certification(s) do you hold? Please specify year(s) of certification.
Briefly describe any mentoring experience you have received
Type and number of years of interpreting experience: please choose the number of years that apply to each area
Educational
K-12 none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Post-secondary none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Vocational none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Community
Legal none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Medical none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Mental Health none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Performing Arts none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Religious none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Rehabilitation/Employment none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Video Relay none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Interpreting for special populations
Oral Interpreting none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Deaf-Blind Interpreting none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Minimal Language Skills/Low-Functioning consumers none 0-1 years 1-3 years 3-7 years 7-10 years 10+ years
Other - please specify
List all post-secondary educational study (Interpreter Education Programs, AA/BA, advanced degrees, etc). Include the name(s) of institutions and areas of study.
Because WRIEC is a federally-funded grant, the following identifications are requested, though not required.
Age: please choose 18-24 25-34 35-44 45-54 54-65 66+
Ethnic heritage: please check applicable and/or multiple identities.
Electronic signature: *required
Date:
Mentor: Please attach current resume or vitae including strengths in mentorship content areas and submit via email submissions, please send to: hallcm@wou.edu
Contact info,
CM Hall, Ed.M. - Mentorship Project Coordinator Western Region Interpreter Education Center Western Oregon University 503-689-5462 (work cell) , 503-838-8731 (v), email: wriec-app@wou.edu
