*****SENIOR
MEMBERS PLEASE FILL OUT THIS SECTION*****
Name:
__________________________________________
Organization:
____________________________________________
Mailing address:
__________________________________________________
City/State:
___________________________________ Zip
code: ___________
Phone:
________________________ Email:
__________________________
Type of employment (e.g.,
academic, consulting, industry, etc.) ______________
Topical interests/Areas of
specialty (e.g., selection, diversity, coaching, etc.):
_______________________________________________________________
Degree type: (e.g., M.A.,
M.S., Ph.D., DBA, Psy.D., etc.) ______________________________
Degree area: (e.g., I/O, OB,
HR, Social, Clinical, etc.) _________________________________
Are you an ethnic minority?*
Yes ____ No ____
If yes, specify ethnicity: _______________
*NOTE: Ethnicity will only be used for matching purposes
in case a junior
member prefers to be matched with someone from a similar ethnic background.
*****JUNIOR
MEMBERS PLEASE FILL OUT THIS SECTION*****
Name:
__________________________________________________________
Organization:
________________________________________________________________
Mailing address:
__________________________________________________
City/State:
_________________________________ Zip
code: _____________
Phone:
________________________ Email:
___________________________
Type of employment (e.g.,
academic, consulting, industry, etc.): ______________
Topical interests/Areas of
specialty (e.g., selection, diversity, coaching, etc.):
_________________________________________________________________
Please indicate if you have specific preferences for a
senior member (e.g., degree level M.A.,
Ph.D., etc.; degree area I-O, HR, OB, Clinical, etc.; ethnic minority
specify ethnicity preference):
________________________________________________________________
Note: Although we cannot guarantee a perfect match on all
of your preferences, we will do our best to match senior and junior members on
as many criteria as possible.
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