WRIEC Mentorship Program
Application for mentors  

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 mentor? *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 teaching or mentoring experience you’ve had (i.e. including where and when you were trained as a mentor).

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.

Institution Degree/Certificate

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: