Mentorship Program | Mentee application form

Please, fill some information about you, your availability and preferences.

Mentorship is a non-formal educational tool for professional development and provides benefits for both the mentee and the mentor. ESPNIC Mentorship program would like to support career development and job satisfaction for less experienced colleagues from all backgrounds and disciplines. It aims at creating a valuable network increasing knowledge sharing, improving interpersonal and communication skills.

Mentor-mentee relationships are built out of personal connection and mutual respect.

More information can be found on the ESPNIC Website.

Question Title

* 1. Your name:

Question Title

* 2. City of residence:

Question Title

* 3. Country of residence:

Question Title

* 4. Gender:

Question Title

* 5. Email address:

Question Title

* 6. Organization and department:

Question Title

* 7. You are working/specialising in...

PICU

NICU

Mixed PICU/NICU

Other (please specify)

Question Title

* 8. Position:

Question Title

* 9. Qualifications (Completed education and training):

Question Title

* 10. I have read the eligibility criteria for mentees and I confirm that I fulfil them:

Question Title

* 11. Languages you feel comfortable speaking during your mentorship

Question Title

* 12. Have you been mentored in ESPNIC before?

Yes

If yes, what is your experience?

Question Title

* 13. What is your preference for communication with your mentor?

Video call (e.g. Zoom, Meet)

Phone/Whatsapp

Face to Face

A mixture of the above

Other (please indicate what it is)

Question Title

* 14. Please Upload your CV:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 15. Please explain why you are applying for the ESPNIC mentorship program:

Question Title

* 16. What would be the theme of your future mentorship? Possible areas include but are not limited to education, research, leadership, and career development.

The more explicit goals you share for the mentorship program, generally, the better mentor allocation our committee can offer.

Question Title

* 1. Your name:

Question Title

* 2. City of residence:

Question Title

* 3. Country of residence:

Question Title

* 4. Gender:

Question Title

* 5. Email address:

Question Title

* 6. Organization and department:

Question Title

* 7. You are working/specialising in...

Question Title

* 8. Position:

Question Title

* 9. Qualifications (Completed education and training):

Question Title

Question Title

* 10. I have read the eligibility criteria for mentees and I confirm that I fulfil them:

Question Title

* 11. Languages you feel comfortable speaking during your mentorship

Question Title

* 12. Have you been mentored in ESPNIC before?

Question Title

* 13. What is your preference for communication with your mentor?

Question Title

* 14. Please Upload your CV:

Question Title

* 15. Please explain why you are applying for the ESPNIC mentorship program:

Question Title

* 16. What would be the theme of your future mentorship? Possible areas include but are not limited to education, research, leadership, and career development. The more explicit goals you share for the mentorship program, generally, the better mentor allocation our committee can offer.

* 16. What would be the theme of your future mentorship? Possible areas include but are not limited to education, research, leadership, and career development.

The more explicit goals you share for the mentorship program, generally, the better mentor allocation our committee can offer.