Be A Certified Professional Mentor (CPM)

Email Address *

Name *



Phone Number

Occupation *

Industry *

Years of Work Experience *

Years of Relevant Professional Experience (Mentoring/Coaching/Counseling): *

Area(s) of Expertise & Interests in Mentoring: *

Your LinkedIn Profile *

Your Short Bio (300 words or less)

1. Please list the specific topics that you are comfortable in providing mentoring support (Provide 3 – 5 areas with a short brief description for each). *

2. In no more than 100 words please state the reasons why you are keen to participate in the CPM Program. *

3. Please indicate 3 mentoring goals you would like to achieve by participating in this CPM Program. *

4. Have you been a mentor before? If YES, please tell us a little about it. *

5. Is there anything else you might want us to know in order to provide you with better support on your mentoring journey? *

8. Are you agreeable to “Pay it Forward” & commit formally, as a Mentor, the required time & effort to successfully see through the full completion of 2 assigned Mentoring Practicums (each of which is for a 6-month duration with a 12-month cycle upon successful completion of all the CPM training sessions - as part of the assessment and evaluation requirement for the completion of the Program)? *

Please kindly submit your profile photo for our database by emailing it to Thank you!