Mentoring Application

Contact Name:*

Contact Phone:*

Contact Email:*

Organization:*

Do you have a collections management policy?

Yes

Please describe briefly the issue or challenge you seek to address through this program:*

Please identify any steps you have taken previously to address this issue or challenge: (VMGA site visits/surveys, CAP or MAP, consultants, or other technical assistance):

I verify that this application is being made with the authorization of the organization’s governing board or authorized personnel:*

Yes

I have read, understood, and will comply with the program guidelines (please see link at the top of this page) :*

Yes

I will make every effort to assist the mentor in scheduling the site visit and will assure that all appropriate staff and volunteers will be available during the site visit:*

Yes

I understand that my organization will pay for the mentor's travel and meals while on site:*

Yes

Contact Information

Company:

First Name:*

Middle Name:

Last Name:*

Address:*

Address2:

City:*

State:*

Postal Code:*

Country / Location:*

At least one phone number is required.*

Mobile Phone:

Home Phone:

Email:*

Thank you!

Vermont Historical Society • 60 Washington Street • Barre, Vermont 05641 • (802) 479-8500
www.vermonthistory.org