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Mentor Interest Form NGGHS Mentorship Program 2020
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* Indicates required question
Please provide your name.
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Your answer
Please indicate the organization with which you are associated.
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Your answer
Please list your address or place of residence.
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Your answer
Please list your contact information, including your phone number, email address, and LinkedIn profile if you have one.
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Your answer
Please indicate your top three to five global health security interests.
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Your answer
Please list your preferred method of communication with protégé, including in person, Skype, email and phone:
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Your answer
Will you be able to correspond regularly with your protégé between April 2020 and December 2020?
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Yes
No
How often do you anticipate you will be able to correspond with your protégé? Please indicate the number of preferred times per month.
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Your answer
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