Document ID: EPA-HQ-OA-2003-0008-0004
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2004-01-05T05:00Z

Draft
­
Final
Version
Will
Have
Additional
Formatting
National
Environmental
Performance
Track
(
Performance
Track)
Mentoring
Program
Registration
Form
Section
1
The
Performance
Track
Mentoring
Program
was
developed
to
facilitate
information
sharing
and
help
applicants
complete
and
strengthen
their
Performance
Track
applications.
The
Performance
Track
Mentoring
Program
is
available
to
any
current
program
member
or
any
facility
that
has
considered
applying
to
the
Performance
Track
program
and
would
like
to
gain
a
member's
perspective
of
the
program
or
is
seeking
personal
assistance
in
setting
environmental
goals
from
top
performing
facilities
currently
in
the
program.
Mentees
are
matched
with
Performance
Track
facilities
that
volunteer
their
time
and
resources
to
share
their
experiences
and
expertise
in
environmental
best
practices.

Please
provide
the
following
information
so
that
we
may
appropriately
match
you
in
the
mentoring
program:

First
Name:
Last
Name:
Title:
Company/
Org:
Mailing
Address:
E­
mail
Address:

NAICS
Code:

Section
2
Please
indicate
whether
you
are
applying
to
become
a
mentor
or
a
mentee:

Mentor
(
If
this
box
is
checked,
please
skip
to
Section
6.)

Mentee
Section
3
Briefly
describe
what
your
site
produces
and/
or
its
functions:

Provide
an
estimate
of
the
number
of
employees
at
your
facility:

Section
4
Please
indicate
in
which
areas
you
would
like
your
mentoring
relationship
to
provide
additional
guidance
(
you
may
check
more
than
one
box):

General
Performance
Track
Information
and/
or
Guidance

EMS
Draft
­
Final
Version
Will
Have
Additional
Formatting

Compliance

Environmental
Commitments

Community
Outreach
Section
5
If
your
site
has
been
working
with
a
current
Performance
Track
member,
please
indicate
which
site:

Contact
name:
Contact
Phone:

If
possible,
would
you
like
to
work
with
this
site
as
your
official
mentor?

Section
6
Please
indicate
which
characteristics
are
most
important
for
your
mentoring
match
(
you
may
check
more
than
one
box):

Similar
industry

Geographic
Proximity

Similar
Size
of
Business

Other,
please
specify:________________________________

If
more
than
one
characteristic
was
chosen,
please
specify
the
most
important
of
the
above
characteristics: