PMI Southwest Indiana Chapter

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PERSONAL INFORMATION

First Name:(*)

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Nickname:

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Last Name:(*)

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Gender:(*)

MaleFemale

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CONTACT INFORMATION

Address 1:

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Address 2:

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City:

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State:

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Zip Code:

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Phone (Work):

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Phone (Mobile):

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Primary Email:(*)

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EDUCATION/PROFESSIONAL INFORMATION

Current Employer:

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Title:

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Functional Area:

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If you are currently a Student, please complete the information below

Institution you are attending:

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Year of planned graduation:

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What is the highest educational degree that you hold?:

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Subject Area Major(s):

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Minor(s):

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MEMBER INFORMATION

Are you a Member of PMI?:

YesNo Invalid Input

Are you a Member of PMISWIC?:

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Type of Membership:

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What PMI Certification(s) do you hold?:

Number of years of experience in project management as PM or team member:

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Please list the Industries and/or Functional Areas in which you have worked

Functional Area:

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Industry:

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What is your reason for joining the Mentorship Program?

Obtain help to prepare for a PMI Certification Exam

I’m new to project management

I'm new to the tristate area and want help to connect to area project management professionals and learn of area professional opportunities beyond being a chapter member

Attained new job responsibilities and need help to increase my knowledge in the following area(s):

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Which PMI Certification are you preparing to take?

Please mention the areas

Please mention the other area or skill

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I need to be able to:

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Industry:

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Functional Area:

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Have you completed the application process to sit for your designated PMI Exam?:

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Have you determined a date when you want to take the Exam?

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Insert the date

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Do you have international experience living and/or working abroad?:

YesNo Invalid Input

List countries

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Do you speak and/or read any languages other than English?

YesNo Invalid Input

Speak and Read

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Speak Only

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Read Only

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Please include any interesting or fun facts about yourself that we can provide to your Mentor(s) in addition to your professional bio/background:

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PMI Southwest Indiana Chapter

PMI Southwest Indiana Chapter

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