PiLA Alumni Mentorship Sign-Up

The purpose of this survey is to help the PiLA team compile and maintain an alumni mentor database to effectively match incoming and current fellows with PiLA alumni and community mentors. In addition to verifying contact information, we seek to gather information related to your fellowship experience, education, employment and fields of interest for mentoring. 

Please note that your interest in participating does not imply a commitment. We will reach out to you to confirm your availability if we find a potential match.

Thank you for your interest in supporting PiLA's alumni mentorship program!

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Section 1: General Information
First Name *
Last Name *
Preferred email (if different than the one on file)
Daytime phone
Current Geographic Location (City, State, Country) *
Current Geographic Region *
Date of Survey Completion *
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/
DD
/
YYYY
Section 2: Fellowship Data
Year of PiLA Fellowship *
Host Country During Fellowship *
Host Organization During Fellowship *
PiLA Fellowship Position Title *
Section 3: Education & Employment Information
Sector of Employment *
Career Focus Areas (Select all that apply) *
Required
Employment Type (Select all that apply, including previous positions you have held and could provide mentorship or guidance about) *
Name of Current Employer *
Current Position Title *
Which of the following degree(s) do you possess or are you in the process of completing? (Select all that apply) *
Required
If you completed an M.A. or an M.S., please indicate your specific field of study *
Please copy and paste a link to your LinkedIn profile below. If you do not have one, or prefer not to share, please enter "N/A" *
Please share a short professional bio that we can share with a fellow in an introductory email. If you do not have one, or prefer not to share, please enter "N/A" *
Section 4: Mentor Preferences
Are you interested in being a Country Mentor, Professional Mentor, or both? *
What is your preferred method of communicating with fellows? (Select all that apply) *
Required
If selected to mentor a fellow, would you be willing and able to dedicate a minimum of 30 - 60 minutes per month to meet? *
If we identify you as a good match for a fellow, do you authorize the PiLA team to share your email address and other information provided in this form with them? *
Please include any additional comments you would like to leave for the PiLA team regarding the mentorship program and your preferences here
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