MENTEE APPLICATION FORM

Thank you for your interest in joining the Women for One Health (WfOH) Network mentorship program as a mentee. Please complete this form to help us understand your background, learning goals, and expectations from the mentorship.

SECTION 1: PERSONAL INFORMATION

Full Name: *

Email Address: *

Phone Number (Optional)

Current Organization/Affiliation: *

Position/Title *

Country/Location: *

SECTION 2 : EDUCATION & PROFESSIONAL BACKGROUND

Education: *

Field(s) of Study/Expertise: *

Briefly describe your experience and/or interest in One Health (max 100 words): *

SECTION 3 : MENTORSHIP INTEREST

What are your goals as a mentee within the WfOH network? (max 250 words) *

What specific areas do you seek mentorship in? *

Preferred Mentor Background (Check all that apply): *

Preferred Mentor: * (Select mentor from applied mentors or expert database): Select mentor from expert database if their name is not in the applied mentors list.

Preferred Mode of Communication with the Mentor (Check all that apply): *

SECTION 4 : ADDITIONAL INFORMATION

Have you previously participated in a formal mentorship program? (Yes/No) *

Yes

Is there any additional information you would like to share regarding your mentorship expectations or commitment level? (Optional)

Declaration

I confirm that the information provided in this application is accurate to the best of my knowledge. I understand that participating in the WfOH mentorship program is a commitment aimed at fostering personal and professional growth in the One Health field.