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Women Mentoring Network (WMN)
Form: Apply As Mentor
Mentor Application
1. First Name
2. Last Name
3. Email
4. Street Address
5. City
6. Postcode
7. State
8. Year of Birth (YYYY)
9. Please Provide Your LinkedIn URL
10. Are you open to mentoring a student older than you?
Yes
No
11. How did you hear about Women Mentoring Network (WMN)?
Facebook
Instagram
Threads
Linkedin
Google
Datin Dr Leez Hassan
Friends
Online Media
Events
12. Select All languages you speak FLUENTLY
English
Malay
Others
13. Current Employer
14. Job Title
15. How long have you been with this employer?
Less than one year
1-5 years
Over 5 years
16. What industry are you in, and how would you describe your professional niche?
17. Can you commit to a minimum of 6 months sessions with a student? Meeting schedules may require flexibility due to time zone and internet capabilities.
Yes
18. ADLA uses the information in this application to review eligibility, match mentors and students, and manage participation in the mentorship program. By submitting this application, you agree to our Privacy Policy and Document Retention Policy, which explain how your information is stored, shared, and protected. I consent to ADLA using the information I provide to evaluate my application, create my program account if accepted, and manage my mentorship experience.
Yes
19. I understand that relevant details (such as my name, email, country, and program information) may be shared with my mentee, ADLA program staff, and partner organizations directly supporting the program.
Yes
No
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