MENTOR-AFE Mentee Candidate Profile form

Personal information

* Surname/Family name

* First name

* Prefix
Check any that apply
* Language(s) that you could use in the mentorship

* Name of your city or community associated with the Global Network for Age-friendly Cities and Communities 

* Full mailing address (including state/province and country)

* Phone number (include country code) 

* Email address

* Skype or other video-chat username(s) and platforms

Education and skills

* Please list your three most relevant qualifications and the year in which they were completed.

  Qualification (degree, programme) Institution Year completed
1
2
3
*

Summarize other qualifications and skills you have acquired from employment, previous volunteer work, or through other activities.


Experience in age-friendly environments

* Please describe your role and responsibilities in relation to your city or community’s age-friendly work.

*

In 300 words or less, describe your main contributions/achievements in the development of age-friendly environments.


Mentorship - objectives

* In 300 words or less, please outline why you are applying for a mentor.  Include information on how the mentoring would complement any other forms of support available to you locally (for example, supervision, support within your workplace, community networks, etc). 

* Please describe a project that you would like to work on with the support of a mentor.  Be specific about the project’s objectives, what your role in the project will be, and on what you would like to work with a mentor.  Please note if you will need approval to be able to undertake this project and how long you expect it will take to obtain approval.

* What are the skills that you most want to develop with the support of a mentor?  This may be one of the MENTOR-AFE skills categories below, or something else you need for your age-friendly work. 
  • Advocating for age-friendly environments and/or the inclusion of older people
  • Building strategic partnerships
  • Facilitating participatory processes
  • Measuring and addressing inequalities
  • Conducting a baseline assessment
  • Developing an action plan
  • Evidence-based programme design
  • Implementing and managing an age-friendly project or programme of work
  • Monitoring and evaluation
  • Analysing and developing policies
  • Imparting knowledge and skills to others
  • Managing and coordinating teams
  • Fundraising
  • Designing and implementing campaigns
  • Communicating and promoting project activities
  • Other. Please specify below    
Please list the top three in order of priority.

* Is there anything that you would like to add on what you would like to achieve with the support of a mentor? 

Mentorship - time commitment and expectations

*

Describe in 300 words or less why you consider yourself to be a good “mentee” candidate for the MENTOR-AFE programme.


*

How many hours each month do you anticipate you’ll spend communicating with your mentor? Include both time spent on video or phone calls, emails, and any other form of communication. 

*

How much time do you anticipate you’ll spend on your mentorship activities other than communications? This will be where you are working on your objectives, putting skills into practice.  It might include time spent on developing proposals, research, or public speaking, for example.


* How many hours per month do you anticipate YOUR MENTOR will spend on communications (emails, phone calls ) and non-communication related tasks ( i.e. reviewing your documentation, compiling supporting materials)

Agreement

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By submitting this application, I confirm that the information provided is accurate.  I understand that there is no financial provision for mentoring, and that any costs of participating will be met by me or an organization that has agreed to support me in this way.  I also understand that the pilot of the MENTOR-AFC will be limited to 20 pairs, and that my selection will depend in part on whether there is an appropriate mentor for me.  Should my application not be successful this time, I may still apply in future years.