BICSI Mentor Application Form

Mentorship Program – 2023/2024

Mentor Application Form



Thank you for your interest in the Mentorship Program. Please complete the form in its entirety. Note all questions require a response to successfully submit the application.  


Are you currently a BICSI member (must be a current BICSI member to be an Mentor)?
Are you willing and able to dedicate yourself to a 1-year Program that will include, at minimum, a 1-hour Mentor/Mentee call per month. Conference attendance suggested, but not mandatory.
Are you willing and able to provide detailed feedback including learning experiences, outcomes, suggestions and assessment of Mentee at conclusion of program?
Please indicate your experience participating in BICSI. Select all that apply.
The following are the BICSI Committees. Please select all you have participated in. Select all that apply.
Note: The code is case sensitive.