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WIL Ottawa Mentor Form 2020
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Section 1: Contact Information
What is your first name?
What is your last name?
For statistical purposes, please indicate if you are:
Person with disability
None of the above
Please include any other of your Social Media page(s) you'd like to be included in your Mentor Profile (ex. Twitter, Instagram):
What is the highest degree or level of education you withhold?
High school degree or equivalent
If applicable, what was/is your major(s) and/or minor(s)?
Section 2: Employment Background
Current job title:
STEM (Science, Technology, Engineering, Mathematics)
Health and Wellness
How long have you been in this position?
> 1 year
If you do, how many employees do you manage?
Describe your professional career background in 100 words or less (main roles, technical skills, responsibilities, managerial experience). This will be used in the Mentor Profile that we will share with your Mentee(s).
Select your top business strengths and areas of business expertise:
Cash flow and/or budgeting
Marketing and/or sales
Organization and admin skills
Satisfaction and worklife baalnce
Overcoming cultural barriers
Strategy planning for business growth
Understanding financial statements
Understanding legal documents
Negotiation and conflict resolution skills
If you choose "Other", please explain:
Section 3: Mentorship Information
How much time on a monthly basis are you able to provide to the mentorship program?
12 hours per month or 3 hours per week
8 hours per month or 2 hours per week
4 hours per month or 1 hour per week
2 hours per month or 30 min per week
What are your top 3 reasons why you wanted to become a mentor?
Build confidence in other women
Assist in finding adequate resources
Help mentees find focus and align their personal and professional goals
Give back to community
Act as a sounding board
Share your experiences and knowledge
Please indicate which type(s) of mentoring you would like to be involved with:
One on one mentoring (Mentor is expected to “check-in” with their mentee between sessions via preferred method of communication (e.g. phone call, email, face-to-face meeting, etc.))
Mentoring group circles (Small groups of mentors/mentees that will meet as part of or outside of organized panel discussions and workshops (based on voluntary participation))
Learning/networking events (Larger groups of participants that will meet as part of our organized networking events and conference (based on voluntary participation))
How many mentees are you willing to mentor?
Do you have any specifications about your mentee(s)? Please describe them below.
Do you wish to be matched with a mentee from the same industry as you?
Do not care
How did you hear about WIL's mentorship program?
Referral from friend/coworker
WIL Social media
Word of mouth
Advertisement from another organization:
If you selected "WIL Social Media", please indicate which one:
WIL National Facebook
WIL Ottawa Facebook
WIL Mailing List
WIL Ottawa Instagram
WIL Ottawa Twitter
WIL National Instagram
Please include any additional comments/concerns:
Would you like to be included in our mailing list to be sent additional and relevant information about WIL organized events? We will never spam you!
Send me a copy of my responses.
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