Mentee Application

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Mentee Application

This is the mentee application form for the Data for Health Gender Equity Mentorship Program.

Personal details

1. Full Name:
*

2. Phone Number (please include country code):
*

Can you receive WhatsApp messages and/or texts at this number?

Yes

3. Email Address:
*

4. Country of current residence:
*

5. Primary language or language(s) you prefer to use with your mentor(s): *

Demographic information

6. Gender:
*

Woman

Man

Transgender woman

Transgender man

Non-binary/ Third Gender

Prefer to self-describe

If you prefer to self-describe, please describe your gender here:

7. Age in years:

Educational background

8. Highest level of education completed:

9. Year of completion of highest degree:

Employment

10. Organization
*

11. Data for Health Program Involvement (check all that apply): *

CRVS

NCDs

Cancer Registries

Data Impact

Global Grants

Other:

Required

12. Country where you work: *

13. Job Title: *

14. How long have you been working in this position? *

15. How long have you been working in this field? *

Mentorship needs and expectations

16. On which aspects of professional development are you looking for mentorship? Keep in mind that all mentorships will be conducted with a focus on gender equity in health data and beyond. (Check all that apply.): *

Maintaining effective communication (e.g., working collaboratively, cross-cultural sensitivity, inclusive language, intentional listening)

Aligning expectations with reasonable goals and objectives (e.g., help team implement strategies and plan with equity and gender lens, support change management)

Addressing diversity (e.g., recognizing own biases, embracing diversity, applying intersectional lens)

Building independence (e.g., career goals, networking, increasing responsibility)

Promoting professional development (e.g., skill development planning, balancing work, and personal life when in caregiving role, aligning values with goals)

Promoting professional integrity and ethical conduct (e.g., developing trust with colleagues, serving as a role model, equitable engagement with colleagues and partners)

Overcoming resource limitations and other sources of adversity (e.g., patience in the face of setbacks)

Fostering institutional change (e.g., advocating for self and others even if that conflicts with traditional gender roles, gender-responsive budgeting, equitable human resource practices)

Technical areas of expertise (e.g., health systems, family planning, civil registration and vital statistics, gender integration knowledge and skills, gender-based violence)

Other:

Required

If you checked "Technical areas of expertise", please specify:

17. Do you have any preferences for the characteristics of your assigned mentor(s)? (Check all that apply.): *

From my country of origin

From my country of residence

Same gender

Same ethnic background

N/A

Other:

Required

If you checked "From my country of origin", please specify:

If you checked "Same ethnic background", please specify:

18. Is there anything else we should know about what you are hoping to gain from this mentorship opportunity focused on gender equity in health data?

For any queries, please send your questions to Vidhi Maniar, Program Manager at the Gender Equity Unit, at vmaniar1@jh.edu.

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