Mentor Registration

Email(Required)

LinkedIn Profile

Full Name(Required)

How would you like us to refer to you?

Example: First name, nick name, title and last name, etc

What region of the world do you primarily live and work in? (Select One)(Required)

What time zone do you live in?(Required)

See time zone map if needed

In a couple of sentences, briefly describe your accessibility background.(Required)

Please include descriptions of projects you’ve worked on and how long you’ve been working in the field.

Briefly describe your goals for participating in this program(Required)

What does success look like?

How many years of experience do you have in Accessibility?(Required)

Briefly describe other areas of expertise

Is English your preferred language?(Required)

Please specify your preferred language

Code of Conduct

The purpose of this code of conduct is to set clear expectations of behavior between all parties involved in the Accessibility Mentoring Program in order to create a positive experience for all participants. This code applies to mentors, protégés and Accessible Community staff involved in the mentoring program.

Key Points

Mutual Respect and Caring – I will respect each individual’s unique experiences, needs, and perspective. I will do my best to be transparent and honest; to communicate my needs and keep the best interest of others in mind. I will try to treat others as I wish to be treated.
Assumption of Best Intent – I will assume everyone involved in this program has my best interest at heart. I will seek to communicate first when misunderstandings or conflicts arise. I will seek outside opinions only after I have tried to (re-)communicate with others. I know that I can reach out to mentoring@accessiblecommunity.org if I need assistance.
Confidentiality – Mentoring requires sharing information about personal experiences. I will respect the confidentiality of conversations that occur during mentoring. I will make reasonable efforts to protect the privacy and confidentiality of my mentor or protégé.
Honor your commitments – I will do my best to keep my commitment as a mentor or protégé and provide the time and attention that participation requires. I will attend meetings at the time scheduled and will have prepared any agreed upon materials.

Emergencies and other unexpected circumstances happen. If I am unable to meet a commitment in the mentoring program, I will communicate this to my mentor or protégé as soon as possible.

Maintain friendly professionalism – I understand that mentoring relationships include both personal and professional aspects. As a result, I will be kind and friendly, while understanding that professional boundaries and behaviors are still required.
Respect for Intellectual Property – I will respect the intellectual property of others including my mentor or protégé and this mentoring program. I will make reasonable efforts to protect the intellectual property of all participants, including my organization’s.

If personal intellectual property needs to be discussed during my mentoring conversations, I will work with my mentor or protégé to define clear boundaries and identify any potential conflicts of interest before discussing intellectual property. We will document those boundaries in an email to mentoring@accessiblecommunity.org.
If I wish to use the materials from Accessible Community outside the program, I will contact mentoring@accessiblecommunity.org to request permission.

Full Name (Printed)(Required)

Typing my name indicate my agreement to abide by the Code of Conduct.

Date(Required)

Reference 1 Name

Please provide the name of a reference who can speak to your background

Reference 1 Email

Reference 2 Name

Please provide the name of a reference who can speak to your background

Reference 2 Email

Name

This field is for validation purposes and should be left unchanged.