1. * Name:
2. City & State:
3. Phone #:
4. Email - so that we are able to keep you informed with news and opportunities:
5. Please check all that apply:
6. If Retired or Left UW, please indicate Year:
7. If retired or left UW, please indicate the UW Name and Location (city/state) where you last worked:
8. If retired or left UW, please indicate your Last Position:
9. Other UWs/Planning Councils you worked at during your career:
10. If still Employed, Employer Name and Location (city/state):
11. If still Employed, current Position:
12. If still Employed, Years to Retirement:
13. Do you speak a language other then English? If so please indicate the language and fluency:
14. Are you Interested - Mentoring a new local UW Executive Director or other staff member for a year? Program includes phone/email contact and possibly 2 on-site visits. Expenses related to program paid by UWRA.
15. Are you Interested - in being a Mentor in the newly launched web-based mentoring program Mentor Scout?
16. Are you Interested - being a Mentor for an International UW - may include phone/email assistance.
17. Are you Interested - being a UWRA Endowment & Planned Giving (EPG) Consultant? UWRA EPG Consultants assist local UWs initiate planned giving programs and conduct at least one on-site visit. Participating UWs pay for the Consultants expenses.
18. Are you interested in helping spread the reach of the Dolly Parton Imagination Library?
19. Are you Interested - in an Interim paid position in the UW field?
20. If interested in Interim positions please check all that apply:
21. If you checked Other above, please indicate the type of Interim Position you would consider:
22. Are you Interested - providing on-site assistance to local UWs in times of a crisis, e.g., flood, hurricane?
23. Please check your areas of expertise, in which you would be available to offer as a mentor or short-term consultant:
24. Have you ever gone to the UWRA website? (If no - please check out www.UWRA.org)
25. Have you ever used the Retirement Planning Corner on the UWRA website? (If no - please check out www.UWRA.org)
26. If you have used the Retirement Planning Corner on the UWRA website, was it helpful?
27. How likely would you be to sign up for an internet based conference (Webinar) discussing retirement or pre-retirement issues?
28. What issues would you most like to see addressed in a Webinar retirement series?
29. What other organizations do you belong to that provide you with retirement-related education and/or support? Please list those that are most useful to you:
30.
