Mentor Sign Up Form
If you would like to participate in the AAZV/WDA/EAZWV Mentoring Program as a MENTOR, please complete the form below.

Application deadline: November 30th 2017
Matchings will be announced in Dec./Jan.

Thanks for participating in the AAZV/WDA/EAZWV mentoring program!
Your Mentoring Program Committee

First name *
Your answer
Last name *
Your answer
Email address *
Your answer
Max. number of mentees you would like to mentor *
Language you are fluent in (please tick all that applies) *
Required
Country (you currently live in) *
Your answer
City (you currently live in) *
Your answer
Current position *
Required
Details of current position (if you ticked 'Other' above)
Your answer
Current employer *
Your answer
Highest degree earned *
Professional focus (please keep your answer short, e.g. wildlife pathology, anesthesia) *
Your answer
Mentee preferences (Please tick all that apply) *
Required
Details of mentee preferences (if you ticked other above)
Your answer
Member of the following organizations (Please indicate all that apply) *
Required
Comments: Is there any other information that could help matching you with a suitable mentee?
Your answer
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