Mentor Application Form

1.First Name:*

2.Last Name:*

3.Gender:

a. Maleb. Female

4.Email:*

5.Phone Number:*

6.Location (City):

7.Highest level of education:*

bachelorsmastersPhDprofessionalvocational

8.LinkedIn URL

9.Organisation:

10.Position:

11.Sector

a. Educationb. Food processing & Manufacturing of Food Productsc. Handicrafts & souvenirsd. Hotels, Restaurants and Cafes (HoReCa)e. ICT services (e.g. SaaS, agtech, clean-tech, e-commerce, edtech, foodtech, healthtech, fintech, and other industry verticals, etc.)f. Retail & E-commerceg. Textiles & Ready-to-wear Garments & accessoriesh. Tourism, leisure & Entertainmenti. Transportation, Storage & Logisticsj. Wholesale & Distributionk. Small scale productionl. Clean energyOther

12.Do you have previous experience as a mentor?*

a. Yesb. No

13. If yes, please provide the name of the organisation/individual with brief description of your mentoring experience.

14. Please, describe why you are interested in volunteering to be a mentor?*

15. Which of these fit your description of interest in volunteering mentorship?*

a. Personal interestb. Professional interestc. Educationd. Society developmente. PEAK Alumni

16. What type of businesses companies (idea stage, startup, MSME) and business sector (e,g, trade, education, tourism, IT, e-commerce, agriculture, services) would you prefer to mentor?*

Stage of development

i. idea stage startupii. early stage startupiii. growth stage startupiv. established SMEs

Economic sector / industry

i. educationii. healthcareiii. tourismiv. ITv. financial servicesvi. e-commercevii. small productionviii. servicesix. agriculture

17. Language proficiency

a. English:

i. no proficiencyii. elementaryiii. intermediateiv. advancedv. native

b. Russian:

i. no proficiencyii. elementaryiii. intermediateiv. advancedv. native

b. Kyrgyz:

i. no proficiencyii. elementaryiii. intermediateiv. advancedv. native

18. Mentor Availability - The Mentorship Programme requires mentors to be available per the scheduled time between mentors and mentees. The Programme requires meeting with your mentee face-to-face, by phone or video and/or through email interaction for at least 4 hours per month.*

a. I am able to allocate 4 hours per monthb. I am not able to allocate 4 hours per month

19. Please provide any other information about yourself that you deem important but is not covered in this form.