Mentor Application

Name*

First Last

Organization*

Email*

Which program stream are you interested in?*

Mentorship
Mentorship + Internship

Why are you interested in becoming a Mentor?*

Please provide a statement of interest in the box below that tells us a little about you and why you think you would be an excellent mentor.

What are some of your TOP ACHIEVEMENTS you would like your mentees to know?*

Have you ever been a mentor?*

Yes - formally
Yes - informally
No

How many hours can you dedicate to the program each month?*

How would you like to interact with your mentees (Please check all that apply)?*

In person
Online (Skype, Google Hangouts)
Email
Over the phone

What qualities do you look for in a mentee?*

If you are selected for summer internship funding, describe what your intern will be working on.*

Please provide a short description of the project(s) the summer intern will work on. (Ex. Creating a social media account for the organization and managing outreach campaigns...)

Proposed duration of internship*

Start date of internship*

End date of internship*

Number of weeks of work*

Number of hours of work per week*

Acknowledgement

If you are selected to be a Mentor and/or host organization, you will be sent a Program Agreement that will outline further details of the program.

I understand that the program involves spending a MINIMUM OF TWO AND A HALF (2.5) HOURS EVERY MONTH.*

Yes, I understand

I understand that the program involves spending a 20 hours per week to supervise the intern and a minimum of 2.5 hours per month for other mentoring activities.*

Yes, I understand