Enrolment Form for Free One-on-One Mentoring Program for Young Women
Please fill out the following form to register for our free one-on-one Mentoring program. This program is designed for young women who are seeking career guidance and mentorship from industry experts. All information provided in this form will be kept confidential. Your detailed responses will help us to map the right mentor to you.

Only forms which have been filled in detail and have met the student selection criteria of the organization will be contacted/selected for the EmpowHER Mentoring Program. Make sure to fill the form in detail to get selected for this initiative.

All the best!

Visit the link for more Student Resources: https://www.canasu.org/canasuforstudents 
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Email
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Full Name
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Phone Number
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Gender
Note: This program is only for Female candidates

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Please enter your date of birth in the format DD/MM/YYYY.
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MM
/
DD
/
YYYY
Which age category do you belong to? *
Required
Languages Spoken

(Select Multiple if applicable) 
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Required
Current Address
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Permanent Address
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Educational status

(If studying in School, please select others from the option below and mention the grade/class in which you are studying)
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Name and address of the School/College/Institution currently studying?

(Example: Name - MES College of Arts, Commerce and Science, Address -  15th cross, prof, MPL Sastry Road, Malleshwaram, Bengaluru, Karnataka 560003)
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Mention your program name and the year in which you are studying

(Example 1: BCOM - 3rd Year, Example 2: 10th Grade - Mid term)
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Where do you see yourself in the next five years? 
(Minimum 100 Words)

Example: In the next five years, I envision myself in a leadership role within a reputable technology company. With my passion for innovation and problem-solving skills, I aim to drive impactful projects and spearhead strategic initiatives that shape the future of technology. Through continuous learning and professional development, I plan to expand my expertise in emerging technologies like artificial intelligence and blockchain. Additionally, I aspire to build a strong network of industry professionals and mentor aspiring individuals to foster a culture of growth and collaboration. By balancing ambition with adaptability, I am confident in my ability to make a positive and lasting impact in the field of technology over the next five years.
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Why are you interested in participating in this program?

(Please briefly describe your career goals and how you hope this program will help you achieve them - Minimum 100 Words)
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What are some of the key areas you are seeking support or help from this program?

(Select Multiple if applicable)
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Required
Do you have 3 hours per week to commit for the Mentoring Program? *
What are your available days for this Mentoring Program? *
Required
What are your available time slots for this Program *
Required
Do you agree to attend all scheduled Mentoring sessions?
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Is there anything else you would like us to know about your availability or circumstances?
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