Embark Project Mentor Application Form
Name and Surname
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Name
Surname
Date of Birth
*
.
Gün
.
Ay
Yıl
2 digit day, 2 digit month, 4 digit year
day-month-year
Gender
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Please select one
Female
Male
Other
If you want to specify, you can type it in the box.
How did you hear about Embark Project? (You can select multiple options)
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Facebook
From a friend
From a Whatsapp group
From school announcements
Instagram
LinkedIn
Twitter
Other
E-mail:
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example@example.com
Phone Number
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-
Area Code
Phone Number
Which city or municipality do you live?
*
When did you come to the Netherlands?
*
.
Gün
.
Ay
Yıl
2 digit day, 2 digit month, 4 digit year
day-month-year
What is your home country?
*
Please specify your official registration status in Netherlands.
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Temporary Protection
Student Visa
Highly Skilled Migrant
Asylum Seeker
Other
Do you have any specific arrangements you would like us to pay attention to or any adjustments you would like us to make for you?
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Motivation
What is your motivation to apply for the program?
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What perspectives or experiences do you hope to share with business leaders?
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Could you please tell us a bit more about your dreams and what makes you feel excited about the future? We would like to know you closer with this question, your authentic answers are appreciated
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Please select topics from the options below in order to discuss in your meetings with your mentee.
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Digital Transformation, Social Media and Trends
What is Leadership? Perspectives of different generations and cultures on leadership, values, attitudes and sources of inspiration
Purpose, Impact and Meaning at Work
Work/Life Balance
Other
Please select the core competencies you would most like to improve for your caeer (You can select at least 1 and up to 3 options. You can add a competency not listed in the menu by clicking on the 'Other' option.)/ Please prioritize the core competencies you wish to enhance for your career development. (You may select a minimum of one and up to three options from the provided list. If a competency you wish to focus on is not listed, kindly specify it under the 'Other' option.)
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Teamwork
Problem-solving
Creative Thinking
Planning/Organization
Self Planning
Adaptability
Digital Skills
Job Search
Social and Professional Networks
Communication
Other (Please indicate)
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Education Information
Education Status
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Student
Graduated
Other
Name of the schools you currently attend and/or graduated from: (max 5 schools)
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What digital tools do you use? (MS Office, Canva, Photoshop, MatLab, the software languages, programs related to your field etc.)
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Please indicate your level for English and Dutch.
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Rows
Level
Any Certificate?
English
Don't Know
Beginner
Intermediate
Advanced
Native
Yes
No
Dutch
Don't Know
Beginner
Intermediate
Advanced
Native
Yes
No
Would you like to add languages other than English and Dutch?
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Yes
No
If you know other languages other than English and Dutch, please add them. You can add multiple languages.
*
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Professional Information
Please share the link to the LinkedIn profile
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Current employment Status:
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Not Working
Working
Internship
Please detail your employment status
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Are you open to new internship opportunities?
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Yes
No
Are you open to new job opportunities?
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Yes
No
In which fields do you apply for job/internship? (You can select multiple. You can add a competency not listed in the menu by clicking on the 'Other' option.)
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Accounting / Auditing
Administrative
Advertising
Analyst
Art / Creative
Business Development
Consulting
Customer Service
Distribution
Design
Education
Engineering
Finance
General Business
Health Care Provider
Human Resources
Information Technology
Legal
Management
Manufacturing
Marketing
Public Relations
Purchasing
Product Management
Project Management
Production
Quality Assurance
Research
Sales
Science
Strategy / Planning
Supply Chain
Training
Writing / Editing
Other (please indicate)
Do you have any professional experience related to your field? (Job, internship, volunteer work, freelance work, projects etc.)
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Yes
No
Please detail your professional experience
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There will be trainings where you will need to use a computer during the training period. Do you have computer and internet access?
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Yes
No
Do you confirm that you commit to attending mentorship training, 4 reverse mentoring sessions, kickoff and closure meeting?
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Yes
No
If you have any thoughts or feedback about this form, please specify.
Please read The Notification of Data Processing
GENERAL DATA CONSENT
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Use of Anonymized or Pseudonymized Data
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I give my explicit consent to Mikado Impact BV to process and use my anonymized or pseudonymized personal data for statistical research, program evaluation, and reporting to institutional funders such as the European Union or private foundations, in accordance with Article 6(4) of the GDPR and as described in the document titled “Notification About the Processing of Personal Data (GDPR)” (Please type: I give my explicit consent)
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