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Mentor Zone Mentee Zone

Mentor Form - 2021 Edition

First name*

Last name*

Number of years of professional experience*		Less than 5 years 5-10 years 11-14 years 15-20 years 20 and more.

Size of the team you are managing*		I do not manage any team Up to 10 people 11-50 people 51-100 people 100 and more.

Number of years of team management in a managerial role*		Less than 5 years 5-10 years 11-14 years 15-20 years 20 and more.

Educational background*		Post-graduate Graduate BA

Do you have any experience as a Mentor?*		Yes No

If yes, are you a certified mentor?		Yes No

If yes, please provide what certificates/ accreditation do you have in detail

Would you be ready to conduct mentoring sessions in English?*		Yes No

Company/ type of business*		Sole trader Family business SME Startup Corporation Public administration body Foundations/ NGOs Partnerships/ corporations/ state treasury companies Schools (colleges)/ R&D institutions Other

Other

Company name*

Sector*

Other

Title/ position*

Other

Unit/ division*

Other

Size of business*		Up to 10 people 11-50 people 51-100 people 101-500 people Over 500 people.

E-mail address*

Telephone number* (please use your country code)

LinkedIn link

City*

CV (DOC or PDF format)* (choose a file)

How did you learn about the Women Leadership in Business Foundation Mentoring Program?		THINKTANK Newsletter Mailing of the Women Leadership in Business Foundation Website of the Women Leadership in Business Foundation Social media (Facebook, Linkedin) The Chamber of Electronic Economy Communication/ newsletter ABSL From the Mentor: (enter full name below) From the Mentee: (enter full name below) Others: (provide source below)

Other

What are the development areas you would like to attend in the Mentoring Program?* (please tick up to 5 boxes)*

Leadership growth area
Leadership competencies in a strategic area
Leadership competencies in an operational area
Building your position in the organization
Supporting other people’s growth
Leading in an international environment
Building your own business
Building a professional network of business relationships

Managerial/ leadership competencies
Enhancing dispute resolution competencies
Effective delegation of tasks and making sure that goals are achieved
Developing and implementing a culture of feedback and feedforward
Change management
Project management
Team-building and driving employee motivation
Building trust and a culture of accountability
Developing and implementing innovative solutions
Inspiring presentation of visions and choice of arguments
Developing influence effectiveness skills
Development of communication skills

Intrapersonal skills
Improved self-confidence in a leadership or managerial role
Emotions management
Building your own image
Striking a healthy work-life balance
Creating a vision and mission for your professional life

What is your experience in the area of mentoring?*


How did you gain your knowledge and tools in the people growth area (e.g. formal training, certificates/ credentials awarded, books etc.)? Please provide a brief description along with several examples.*


What technical competencies will you contribute to the Mentoring Program?*


What are your principal/ key personality traits?*


What do you expect to achieve as a Mentoring Program attendee?*


Have you ever had a Mentor? If yes, what were the results of your collaboration? Please provide a brief description with no confidential information included in it.*


What are your interests and hobbies?*


People nominated for membership of the Mentoring Program with a discount (up to 2 individuals)


I voluntarily give consent to my personal data being processed for the purpose of candidate matching and participation in the Mentoring Program and the Women Leadership in Business Foundation Mentee Club and to contact me via email and by phone for this purpose.*

I voluntarily give consent to my personal data being processed for direct marketing purposes by the Women Leadership in Business Foundation (updating me on ongoing projects, research, meetings and workshops) and contacting me via email and by phone for this purpose. I acknowledge and agree that: The controller of my personal data is the Women Leadership in Business Foundation, ul. Ogrodowa 58, 00-876 Warszawa. The Data Protection Officer is Jarosław Kępski, email address: iod@liderkibiznesu.pl. The legal basis for processing my personal data I provided in the registration form is my voluntary consent given above to my personal data being processed for the purpose stated above. The recipients of my personal data will be persons and assistants supporting the Women Leadership in Business Foundation to realize its goals. My personal data will be processed by the controller until I request that my data be erased unless other provisions of law require otherwise. I have a right to access and rectify my personal data and request a copy of my personal data. I have a right to request that the processing of my data be limited. I have a right to request that my personal data be erased. I have a right to request that my personal data be transferred. I have a right to file a complaint to a supervisory authority (Director of the Personal Data Protection Office, ul. Stawki 2, 00-193 Warszawa).

I acknowledge that the role of a Women Leadership in Business Foundation Mentor is a pro bono activity to promote diversity in business and develop competencies of a young generation of leaders. I have read and express my acceptance of the Rules of the 8th Mentoring Program.*


		Please select from 1 up to max 5 boxes

*Mandatory boxes

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