Mentorship Program

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Mentorship Program

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Name*
First Last
What is your date of birth?*
What gender do you identify with?
- Female
- Male
- Prefer not to say
- Other

Please provide us with email address*
What is the best telephone number for us to reach you?
In which country do you live?
Please state your city*
Are you interested in being a mentor or a mentee?*
- Mentor
- Mentee
What is your occupation?
- Working Professional
- Full-Time Student
- None
Please state your job title
Name the company/organization you work for
What is the highest education level that you have obtained?
- Secondary School Diploma
- Associate Degree or Technical/Vocational Certificate
- Bachelor's Degree
- Master's or Greater
- Other:
If you are either a full-time or part-time student, please state the name of the institution you are attending. If you are a working professional, please state the name of the last institution you attended. *
What is your year of graduation or predicted year of graduation?
Please select your field of study.
Please select your preferred field of interest? For mentors, please select the field that you are currently working in. For mentees, please select the field you are interested in working in
Of the selections from the image below, which selection do you think best matches your personality?
In NO LESS THAN 50 WORDS, please describe yourself. Feel free to include information about hobbies or volunteer interest, career aspirations, life goals, etc. *
What are you hoping to get out of the program and this experience? Please give as many details as possible.
Do you have any prior experience with mentorship?
- Yes
- No
- Maybe
Are you comfortable with being matched with someone outside of your field of interest?
- Yes
- No
- Maybe
Are you comfortable with being matched with someone outside of your geographic location?
- Yes
- No
How did you find out about our program?
- Facebook post
- Friends or family
- Email
- Other

@Dream & Success Initiatives Inc.

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