I would like to become a NJ media mentor

Use this form to give the Center for Cooperative Media your information so we can connect you with up-and-coming and early career journalists or publishers from across the Garden State. You have a lot of knowledge and insight to share, and we want to make sure you can link up with people who need it the most! If you have questions about this form or this project, please don't hesitate to email the Center at info@centerforcooperativemedia.org.

First name

Last name

Public email address

Please provide an active, public email address where the Center and potential mentees can reach you.

Phone number

Please provide a phone number where Center staff can reach you. (NOTE: We will not share this number with ANYONE unless you give explicit permission.)

Do you identify with any of the following groups?

We ask this question because the Center is committed to ensuring that our mentors and mentees are a diverse group of people with insights and perspectives from a wide range of experiences.

How would you describe your current professional status?

Where are you in your career? This will help us determine who to pair you up with in the future.

What kind of expertise or experience do you bring to the table?

What are you willing to share with potential mentees? Please select all that apply.

Professional bio

Please use this field to tell us about your professional history and experience. What is your story? (NOTE: You can use rich text formatting in this field, including hyperlinks and bold or italic text.)

Share your LinkedIn or professional portfolio

Please post the URL to your LinkedIn profile or any other online professional portfolio you maintain.

What is your preferred method of communication?

How would you like the Center and/or potential mentees to contact or interact with you? Select all that apply.

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