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 and increase knowledge sharing, improve interpersonal and communication skills.

Mentor mentee relationship built out of personal connection and mutual respect. 

A mentor is a healthcare professional (HCP) who has a special interest in another person develop into a successful professional and has solid experience in the field (clinical, leadership, research or education). A mentor acts as a guide and role model for a new or less experienced HCP or a (senior) HCP who wants to further develop their career.
More information can be found on the ESPNIC Website.

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* 1. Your name:

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* 2. Personal address:

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* 3. City of residence:

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* 4. Country of residence:

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* 6. Email

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* 7. Organization and department:

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* 8. Position:

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* 9. Qualifications

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* 10. Languages spoken:

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* 11. Would you prefer a mentee in your own language?

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* 12. Which aspects of ESPNIC mentorship program would you be prepared to offer mentorship in? (tick all that apply)

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* 13. Have you been mentore before?

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* 14. What is your preference of communication with your mentee? (tick box)

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* 15. Please Upload you CV

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