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First Name
Last Name
Phone Number
Location
Company
Please provide quick summary of your career so far?
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What subjects or technical areas are you interested in?
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What do you hope to get out of this mentoring scheme?
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Have you had any experience in the past of being mentored or do you currently have a mentor now?
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What personal development areas would you would like to work on with you mentor? e.g work/life balance, confidence, fear of failure etc.
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Having spoken with your peers, what has been your feedback regarding your strengths and weaknesses?
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Are you currently a leader to people, or a leader to leaders, if so which one and would you consider being a mentor in the future?
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Having looked at the Mentors on the website please advise your top 3 mentors choices and why.

1. Mentor name
Why would this mentor be best for you?
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2. Mentor name
Why would this mentor be best for you?
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3. Mentor name
Why would this mentor be best for you?
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This is charitable organisation to help build women’s careers and so expenses for travel to meet with mentees cannot be reimbursed.

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