Mentee Profile – Women Leaders South Africa

Mentee Profile

33%

Name and Surname*
Gender*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Contact Details*
Email Address*
Profession / Grade*
Mentee Image (.jpg, .png or .jpeg files accepted)*
Accepted file types: jpg, png, jpeg, Max. file size: 512 MB.

How would you describe yourself?*
What are the 3 major challenges you are experiencing and trying to overcome at the moment?*
In 3 years time, what would you like to have achieved/be doing?*
What kind of commitment are you willing to make to a mentoring relationship? How formal? Frequency of meeting?*
I am interested in the following speciality areas * Choose all that apply*
- Sports
- Events and Marketing
- Informatics/Technology/Technical
- Food Service/Culinary
- Communication/Writing
- Entertainment
- Education
- Community Dev./Social Change
- Not sure yet
- Other
If other, please describe
Do you have a gender preference for your mentor? If so, identify which gender you would prefer to be matched with.*
- Male
- Female

Are you looking for someone who?
Uses connections to promote and create career opportunities*
- Yes
- No
Example
Provides academic guidance*
- Yes
- No
Example
Assists in planning for the future and determining ways or methods of achieving desired goals*
- Yes
- No
Example
Prepares you for professional growth/leadership development*
- Yes
- No
Example
Provides advice, assistance and guidance on a more personal level*
- Yes
- No
Example
Increases your self‐awareness by giving feedback to assess thinking and development*
- Yes
- No
Example
If other, please describe
Consent*
I declare that the application is my own, original work and the information provided is the truth.
Signature*
Date*
MM slash DD slash YYYY
Name
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