MENTEE APPLICATION FORM



|MENTEE APPLICATION FORM |

|If you are interested in participating in the mentoring programme, please complete the on-line application form and send it to amp@ by 5 February |

|2021. |

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|Providing the following is for the sole purpose of matching each Mentee with a suitable Mentor. |

|PERSONAL: | |

|First and Last Name: |      |

|CONTACT DETAILS: | |

|Position: |      |

|Institution: |      |

|Country: |      |

|Email: |      |

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|CONCISE DESCRIPTION OF YOUR ROLE AT YOUR |      |

|INSTITUTION: | |

|(max 100 words) | |

| | |

|ACTIVITIES AND |      |

|INTERESTS: | |

| | |

|CAREER CHOICE |      |

|State if there is anything you would | |

|particularly like to achieve in your | |

|professional/personal life that you feel a | |

|Mentor could support you with. | |

| | |

|WHAT HELP WOULD YOU LIKE TO RECEIVE FROM A |      |

|MENTOR? | |

|Mention if you have any strong preferences | |

|about what you are looking for from a | |

|Mentor: | |

| | |

| |      |

|REASONS FOR APPLYING TO THE ABSTRACT MENTOR | |

|PROGRAMME | |

| | |

|ABSTRACT TITLE |      |

|DRAFT ABSTRACT |      |

|(400 words maximum) | |

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| | |

| | |

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|TECHNICAL SESSION FOR ABSTRACT SUBMISSION |      |

|(please indicate code and title/ | |

|Ex: A1.1 Behaviour, Performance and | |

|Psychosocial Issues in Space) | |

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