Mentor application form 
Thank you for applying to be a mentor in the MiS Mentoring Program. This is the only mentoring program specifically designed to support mothers in STEMM and address their unique challenges - with mothers supporting mothers. We are truly grateful for your support and look forward to reading your application.

This application form is confidential and your information will never be shared without your consent.

Completing this form is critical for us to match you with the appropriate mentee. This form should take approximately 10-15 minutes to complete. Thank you!
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Full Name *
Email *
Twitter handle
Age *
Country of residence *
Ethnicity
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Nationality *
Are you currently *
Field or research/work *
Current employment status? *
How many years of work experience do you have since completing your PhD? *
Number of children *
Relation status *
Languages spoken
Have you been a mentor before? *
On what areas do you believe you can provide support to your mentee- where do you think you can most positively impact your mentee's career? Please select a maximum of 3 options.  *
Required
Who would you prefer to have as a mentee? Please select a maximum of 3 options. *
Required
Why do you want to be a mentor in this mentoring program? Please be as specific as possible. *
To find a mentee who is a perfect match for you, we need to know more about you. Please give a brief overview of your career and motherhood journey, detailing your current job and main responsibilities, as well as your career goals. Please aim for 100 words.
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Participating in this mentoring program would require a commitment of at least 4 one-hour meetings within 6 months, plus any possible preparation time. Are you able to commit to this time frame?
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Are you willing to communicate regularly and openly with MiS team members, provide information regarding your mentoring activities, and receive feedback regarding any difficulties during your participation in this mentoring program?
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What is your greatest challenge as a mother in your career? *
What qualities, skills or other attributes do you feel you have that would benefit your mentee? Please explain.  *
By checking this box, I have reviewed and agree to the terms and conditions of the Privacy Policy of Mothers in Science. Please read our Privacy Policy: https://www.mothersinscience.com/privacy-policy
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THANK YOU! We will get in touch with you as soon as possible.
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