INDEED 2016 MENTOR APPLICATION FORM

Application deadline – 10 March, 2016, 23.59 WIB.

Thank you for applying this mentor application form. Mentors are required to commit around 2 hours per week during the period of the program (April – September). Application will be received until 5 March, 2016, 23.59 WIB, and selected mentor will be announced by March 10, 2016.

Full Name *

First Name Last Name

Birthdate *

Month Day Year Date Picker Icon

Phone Number *

Area Code Phone Number

E-mail *

Skype ID

Google Plus ID

WhatsApp Number

Line ID

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mentees are applying to different levels of education: masters and Ph.D. For application to what level of education are you willing to mentor? *

Master PhD (doctoral)

The Mentorship program will require time commitment of at least two hours per week for the period between April to September 2016. Will you be committed to allocate the required time including reviewing mentee’s assignments and having one-on-one feedback sessions? *

Yes No

Are you willing to accept and cooperate with any mentee who is assigned to you? *

Yes No

Most communication during the mentorship program will take place over emails, Line/whatsapp, skype sessions, or phonecalls. Are you willing to prepare technical arrangements to enable such communications, including to pay for your own communication expenses? *

Yes No

Most communication during the mentorship program will be in English. Are you comfortable in using English verbally and in writing during the program? *

Yes No

School application is a personal process, and werespect the rights of privacy of the selected mentees regarding their application process. Are you willing to maintain the anonimity of the selected mentees during and after the program? *

Yes No

INDEED 2016 Mentor Application Form

1. Personal Information

2. Academics

3. Professional Experience