Care Mentors

Mentorship

Mentorship Application

Mentorship Program Application

Welcome to the application form for the Mentorship Program. This program is designed to connect aspiring STEM students with experienced professionals for guidance, support, and networking opportunities. Please fill out the form below to apply for the program. Your responses will help us match you with a suitable mentor.

First Name

Last Name

Email *Please fill the required field.

Subject

Age *Please fill the required field.

Gender *

Male

Female

Non-binary

Please fill the required field.

Phone *Please fill the required field.

Field of Study *Please fill the required field.

Why are you interested in the Mentorship Program?

What career field are you interested in pursuing? *Please fill the required field.

What are your short-term and long-term career goals? *Please fill the required field.

What do you hope to gain from this mentorship experience? *Please fill the required field.

Do you have any previous experience with mentorship programs ( either as a mentor or a mentee) If yes, please describe:

How do you prefer to communicate with your mentor? *

Phone

Video Call

In-person

Do you have a specific industry or profession in mind for your mentor? *Please fill the required field.

How frequently would you like to interact with your mentor? *

Weekly

Bi-weekly

Monthly

Please fill the required field.

What days/times are you generally available for mentoring sessions? *Please fill the required field.

Are there any additional factors or considerations you would like us to take into account when matching you with a mentor?

Is there anything else you would like to share about yourself?

By participating in the mentoring program, you agree to maintain professionalism in all interactions with your mentor. *

Yes

By submitting this form, I consent to my information being used solely for the purposes of participation and administration in the Mentorship Program. *

Yes

Please fill the required field.

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