Mentor interest - application form
Thank you for your interest in becoming a mentor for the Sixty Twelve program. Your insights and experience will play a crucial role in shaping the next generation of digital health leaders. 

We'd love if you could please take a few minutes to complete this form so we can gauge your interest(s) and look to match you with the most suitable mentee to ensure that your mentoring experience is as rewarding as possible.

Please note that for now and the immediate future the program itself is non-profit and so the mentor position will be voluntary only - please only fill in the below form if you wish to proceed as a volunteer mentor.

If you're interested in becoming a mentee, please fill in this form for mentee applications. 

Email *
Name *
Email *
LinkedIn profile: *
Website (if applicable):
Current role
Please briefly describe your professional background (e.g., career milestones, areas of expertise, industries worked in)
Do you have any prior mentoring experience? If yes, please briefly describe.
Do you have any additional skills, experiences, or perspectives that you believe would benefit your prospective mentee(s)?
What are your specific areas of expertise or interests within healthtech? (Please check all that apply):
How much time could you dedicate to mentoring per month?
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Would you prefer to mentor: 
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Would you prefer to mentor: 
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Do you have a preferred time for mentoring sessions?
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Are there specific career stages of mentees you’d prefer to work with? (Please check all that apply):
Would you like to be matched with mentees based on shared professional interests or complementary skills?
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Would you be willing to provide feedback throughout the program to help us improve?
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Would you be interested in attending in-person networking events as part of the programme?
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