Mentor Application First Name Residence country & address: Date: Cell Phone: Email Secondary Email: Emergency/other phone: Other Emergency Phone Number Select your age group: 20-30 30-40 40-50 60-70 70-80 Gender: Male Female Education Completed: Career/professional experience: Please answer all questions as completely as possible. If more space is needed, use an extra sheet of paper or write on the back of this page. 1. What category of subjects do you choose to mentor in this platform? A. Personal Development Mentoring, per platform topics B. Academic or Professional Skillset Mentoring, per platform topics C. Both (Personal Development + Academic/Professional Skillsets) 2. What relevant knowledge-base and experience you have in order to mentor Ethiopians in your chosen categories? 3. Are you willing to strictly be committed and follow all the platform intentions and values; rules; Mentee identified goals; shared Mentee-Platform visions and mentorship topic objectives including lesson plan idea frameworks? Yes, always: Yes, but sometimes: May be, mostly: 4. Why do you want to become a Mentor on this platform? 5. Do you have any previous Mentoring experience, or community setting volunteering service as a Mentor? If so, please specify. 6. What special qualities, skills, personality or other attributes do you feel you have that would benefit a Mentee? Please explain. 7. Can you commit to participate in the Project Uplifting Ourselves mentoring program for a minimum of one year from the time you are matched with one or more Mentees? Yes No 8. Once committed, are you available to meet with a Mentee absolutely prepared to provide service at least 2 hours per week, as that is the minimum requirement? Yes Mostly: Sometimes: Maybe: 9. Please estimate any potentialscheduling issues you mightsuspect to occur soon, (if any). 10. Describe your general health. Are you currently under a physician’s care or taking any medications? If so, please explain. 11. How would you describe yourself as a person? 12. How would your friends, family, and co-workers describe you? 13. Have you ever been arrested or convicted of a crime? If so, what were the circumstances? Yes No 14. Are you willing to communicate regularly and openly with program staff, provide any and all information regarding your mentoring activities upon request? Yes No 15. Also willing to receive feedback regarding any difficulties during your role as a Mentor? Yes No 16. Participate in all program evaluation surveys when asked? Yes No 17. Are you willing to abide by all platform rules and instructions, attend an initial mentor training session and two in-service training sessions per year after being matched? 18. Based on your choices above, please describe the areas which you can be helpful in providing mentoring. 19. Is there any characteristic in a mentee that you may be uncomfortable handling, or special Mentee type preferences? Please specify. 20. Please specify if you prefer a one-on-one mentoring session or a group mentoring session. Thank you very much. We will contact in an email shortly.
