First Name *

Middle Name

Last Name *

Email *

WWN Member ID *

Phone *

Age *

Sex *

City * []

State / Province * []

State - If Other []

Country * []

Race *

If other:

Ethnicity *

Were you an international participant? *

If yes, select country

Educational Attainment *

If other:

Fields of Study *

If other:

Current Place of Employment *

Current Job Title *

Income *

Can you devote 6 months of mentorship? *

Why do you want to join this programand what do you hope to gain from participating? (500 words max) *

What challenges have you encountered in your career field as an underrepresented individual and how did you overcome them? (500 words max)*

Where do you see yourself in the next 3-5 years? (200 words max)*

Mentorship Program
Code of Conduct

Peers will not practice, condone, facilitate or collaborate in any form of discrimination on the basis of ethnicity, race, sex, sexual orientation, age, religion, national origin, marital status, political belief, mental or physical disability, or any other preference or personal characteristic, condition or state.
Peers will respect the privacy and confidentiality of their Mentors and others utilizing peer support services.
Peers will never engage in sexual/intimate activities with their Mentors and others utilizing peer support services.
Peers will avoid conflicts of interest that compromise the relationship between themselves and theirMentors.
Peers will never intimidate, threaten, harass, use undue influence, physical force or verbal abuse, or make unwarranted promises of benefits to their Mentors and others utilizing peer support services.
Peers will not accept gifts of significant value from their Mentors and others utilizing peer support services.
Peers will maintain high standards of personal conduct that includes keeping commitments to and giving of dignity and respect to all people.

I agree to the Privacy Policy

I agree to the Code of Conduct

Mentee Profile