Application Form for Mentees

This application form will help us with the choice of participants. If you wish to be accepted into the Mentoring-Program we will send this form to your potential mentor for providing her with information about you. Therefore please furnish your particulars in a way that they will be helpful for us as well as for the mentor.

Name
Adress
Telephone
E-mail
University degree
Doctoral subject
Dat of birth / Kinder
Kinder children yes no

A.Expectations for the Mentoring-Program

  1. What do you personally expect from participating in the Mentoring-Program?
  1. Which questions and topics would you like to clarify or discuss within the scope ofthe Mentoring-Program?
  1. The Mentoring-Program subsists on the commitment of all participants. Which skills, interests or experiences could you introduce in order to support the program?
  1. Besides the conversations with your mentor another important aspect of the program will be networking activities. On which of these topics would you like to attend a meeting or a workshop? (please tick a maximum of three topics):

0Self-presentation/self-marketing in academia

0Application in academic realms

0Conflict management

0Leadership/managerial competence

0Work-Life-Balance/ compatibility of family and academia

0Milestones in the academic career

0Academic writing

0Other topics: ______

B.Professional Career

  1. Please shortly present your current professional situation. (State of your doctoral project, content focus/working title, supervision, manner of financing)
  1. Which professional goals do you pursue? Where do you want to be in 10 years occupation-wise?

Please give us your complete application form as well as yourtabular curriculum vitae. You can also put in in our mailbox or e-mail it to us:

Mentoring-Programm für Doktorandinnen
Universität Paderborn
Fakultät für Kulturwissenschaft
Warburger Str. 100
33098 Paderborn / Dr. Julia Steinhausen
Office: H4.127
Mailbox“Mentoring-Programm” (in front of H4.135)

If you will be accepted into the Mentoring-Program we will hand your application form over to your potential mentor and will also use it for evaluating our program. For this we need your consent:

Declaration of consent:

I agree that all of the aforementioned information can be included into the mentee-file of the Paderborn Mentoring-Program. The data will only serve for establishing contact by the coordinator, for passing on to potential mentors and for an anonymized form of evaluating the program.

My legal right to information, rectification, deletion and blocking of data (pursuant to §§ 18, 19 Landesdatenschutzgesetz NRW) will not be influenced by this declaration.

Place, DateSignature

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