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Research Mentor Form
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Personal Information
Name
*
First
Last
Email
*
Phone Number
City
Country
LinkedIn Profile or Professional Website
Professional Background
Current Position/Title
Organization/Institution
Highest Degree Earned
Area of Specialization
Years of Professional Experience
Less than a year
1
2
3
4
5
6
7
8
9
10
10+
or ideas, Organization/Institution
Expertise and Interests
Primary Field(s) of Expertise (Select all that apply):
Engineering and Technology
Business and Economics
Environmental Science
Arts and Humanities
Healthcare and Medicine
Social Sciences
Other (Please Specify)
Please Specify Primary Field of Expertise:
Areas of Interest for Mentorship (Select all that apply):
Research Guidance
Career Counseling
Academic Writing and Publishing
Project Development
Other (Please Specify):
Areas of Interest for Mentorship:
Preferred Mode of Engagement
Online (Webinars, Virtual Meetings)
In-person (Workshops, Seminars)
Both
How much time can you dedicate to mentorship per month?
1-5 hours
5-10 hours
10+ hours
Would you be open to participating in group mentorship sessions or panel discussions?
Yes
No
Do you have any specific projects, ideas, or topics you'd like to mentor on?
No
Yes (Please provide details)
Projects, ideas, or topics you'd like to mentor
Supporting Documents
Upload Your Resume or CV
*
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Upload Additional Supporting Documents or Publications
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Agreement
I confirm that all the information provided is accurate to the best of my knowledge.
I agree to adhere to the guidelines and code of conduct for Research Mentors
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