2025 Mentorship Program | Mentee application form

Please, fill some information about you, your availability and preferences.

Mentorship is a non-formal educational tool for professional development and provides benefits for both the mentee and the mentor. ESPNIC Mentorship program would like to support career development and job satisfaction for less experienced colleagues from all backgrounds and disciplines. It aims at creating a valuable network increasing knowledge sharing, improving interpersonal and communication skills.

Mentor-mentee relationships are built out of personal connection and mutual respect.

More information can be found on the ESPNIC Website.

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* 1. Your name:

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* 2. City of residence:

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* 3. Country of residence:

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* 4. Gender:

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* 5. Email address:

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* 6. Organization and department:

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* 7. You are working/specialising in...

PICU

NICU

Mixed PICU/NICU

Other (please specify)

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* 8. Position:

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* 9. Qualifications (Completed education and training):

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* 10. Please indicate if you have checked the eligibility criteria for mentees and confirm that you fulfill them:

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* 11. Languages you feel comfortable speaking during your mentorship

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* 12. Have you been mentored in ESPNIC before?

Yes

If yes, what is your experience?

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* 13. What is your preference for communication with your mentor?

Video call (e.g. Zoom, Meet)

Phone/Whatsapp

Face to Face

A mixture of the above

Other (please indicate what it is)

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* 14. Please Upload your CV:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 15. Please explain why you are applying for the ESPNIC mentorship program:

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* 16. What would be the theme of your future mentorship? Possible areas include but are not limited to education, research, leadership, and career development.

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* 17. Please formulate and state one up to three distinct and concise goals, ambitions and/or plans that you wish to achieve within the mentorship program

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* 1. Your name:

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* 2. City of residence:

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* 3. Country of residence:

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* 4. Gender:

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* 5. Email address:

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* 6. Organization and department:

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* 7. You are working/specialising in...

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* 8. Position:

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* 9. Qualifications (Completed education and training):

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* 10. Please indicate if you have checked the eligibility criteria for mentees and confirm that you fulfill them:

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* 11. Languages you feel comfortable speaking during your mentorship

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* 12. Have you been mentored in ESPNIC before?

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* 13. What is your preference for communication with your mentor?

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* 14. Please Upload your CV:

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* 15. Please explain why you are applying for the ESPNIC mentorship program:

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* 16. What would be the theme of your future mentorship? Possible areas include but are not limited to education, research, leadership, and career development.

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* 17. Please formulate and state one up to three distinct and concise goals, ambitions and/or plans that you wish to achieve within the mentorship program

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* 18. Please provide a short bio and present who you are as a person (maximum 4 sentences/ 200 words):