Sign in to your Google account to fill out this form
This form contains features which require sign in. Your identity will not be revealed.
Application Form for Mentoring Program 2017-18 ( Mentor)
NIWS @ SwAr Ashram • 1 KVN Narmada Ghat • Maheshwar, MP 451224
'Namaste' is a greeting of honor & respect. 'Didi' is Hindi for 'elder sister'.
Welcome to ‘Namaste Didi’ Mentoring Program 2017-18 Application! A Project under the the direction of NIWS Shakti Projects, girl’s and women’s empowerment initiatives. We are very glad to know you are interested in participating in our program to assist a young woman towards achieving her dreams. Please carefully read this application. Make sure the information you provide is complete and accurate. You will need to submit this form before May 1st, 2017 at 12pm for consideration. If you have any question/issue, do not hesitate to reach Amma Niradhara -
or by phone 9522782777
Mentor Applicant's Name
How would you like a Mentee to address you?
Full Current Physical Address
Completed Level of Education
Applicable Past Occupation(s)
Are you now (or in the past) participating in any other Mentor Program?
If, which one?
When was it?
If 'yes', please describe your experience -
Please describe any goals you have for this mentoring relationship -
Are you able to commit to at least 2 hours per month for 1 year?
Are you able to travel to meet your mentee if necessary?
Preferred age level for mentee who you would be matched with? (we will do our best but this is not a guarantee of the Mentee's age)
1st year College
2nd year College
3rd year College
4th year College
Tech or Specialty School
Is there a known Mentee you would like to be matched with? Please write her name.
Groups and Activities
Hobbies and Interests
Short questions: Briefly write about your main idea and points, as well as being explanatory. Check the box when all 4 below are complete.
i have answered all 4 Short Questions to the best of my ability.
1. In one paragraph explain why you want to participate in the “Namaste Didi” Program?
2. Do you believe that interaction with a mentee from a developing country would be beneficial to her goals? Why?
3. Do you believe that interaction with a mentee would be beneficial to your goals? Why?
1. Describe yourself as fully and accurately as possible in the 140-character limit of a tweet.
Essays : This is the opportunity for you to show us what you have to offer. You are about to write two essays: 1. Personal Statement is required for all applicants. Describe the world you came from and how that shaped who you are. Describe the way you would like to shape your future world. 250 - 650 words.
Choose ONE from the below Essay choices. 250 - 650 words. Choose that essay's number here
1. What are you passionate about?
2. Describe an experience where you were unsuccessful in achieving your goal. What lessons did you learn from this experience?
3. What movie, poem, musical composition, or novel has most influenced your life and the way that you view the world?
4. Remember a time or environment that is particularly significant to you. Describe the scene in detail, tell us why it is meaningful to you.
Required documents: We ask you to supply some documents in good quality copy. After submitting this form, in jpg format send the required docs to
with subject NAMASTE DIDI)
Your Current Photo ID
Your Current Resume or CV
Did you have any problem while filling out this form?
If so, please describe -
Do you agree to submit to us your personal, financial and educational information being aware that we may share necessary parts of this information with the prospective mentee(s) at the time of matching and will use this information only for ‘Namaste Didi’ Program's purposes?
After you submit this Application Form, you will not be able to do any changes or remove any information. You confirm to be submitting only truthful information, otherwise your Application may be rejected and you will not be accepted for the Program 2017-18. Submitting this form does not guarantee that you will be matched with a Mentee this year. If selected and matched with a Mentee for this program, you will be notified by the email address you have supplied above. If selected and matched, the duration is for 12 months term, to commit to a minimum of 2 hours per month in dialogue with your Mentee (24 hours total for the year), with opportunity to re-evaluate and re-new if all parties are in agreement. Yes, I agree / Understand the above terms of this application.
by ticking this box, I AGREE to the above terms
SIGNATURE - type your full legal name. If printing this application, please sign here, then scan and email to
or post to Amma Niradhara - SwAr Ashram - 60 Jai Rajrajeshwar Chowk - Maheshwar MP India - dist: Khargone - Pin Code 451224
date signed / submitted
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service