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Mentorship application
 

Mentorship application

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    Mentorship application Mentorship application Document Transcript

    • Application for mentors program Agri-business incubator- ICRISAT Patancheru 502 324, Andhra Pradesh, India (NIABI Form I A) Photo(Note: You can tick multiple choices) Domain areas in which you would like to mentor Agriculture Horticulture Agri-input Agri-processing Incubation Dairy Fishery Biotechnology Agri-engineering other Specific details: ___________________________________________________________________________________________ Functional areas in which you would like to mentor Marketing Consultancy Business Fund raising (Angel/VC/Grants/Debts Quality control Legal/IPR other Specific details: ___________________________________________________________________________________________PERSONAL DETAILS Name WORK EXPERIENCE: Please list the name of the organizations along with the designation, industry type Age have worked with. you Address Name of Designation Period Specialization Briefly describe the nature of work organization (From-To) Phone(mobile) Email ID Language proficiency Geographical areas where you want to mentor 1
    • BUSINESS QUALIFICATIONS: Please list any business training programs or course that you haveundertaken Title of the training program Organizing Duration of the Year of completion agency trainingPROFESSIONAL AFFILIATION: Please list any professional organizations or committees you areFORMALwith.associated EDUCATION QUALIFICATION: Please detail here any degrees, diplomas, trade certificatethat you may have. Name of the Position in the Period Briefly describe the nature of your work Degree organization Period organization Institute/ Specialization % Marks obtained Obtained (From – To) university 2
    • ACHIEVEMENTS: Briefly describe your achievements in your career life.1.2.3.4.5. 3
    • ABOUT YOUR BUSINESSCompany nameAddressPhoneYear of operationSole owner/Partnership/ Pvt.Ltd/ Public Ltd/ OtherIndustry TypeSub area of BusinessDescribe your business: 4
    • What is your role in thebusiness?Performance Snapshot:(sales, turnover, profit etc.)Financial Performance:(Please attach last two yearsfinancial statement of thebusiness.)ABOUT MENTORING Everyone chooses to mentor for a variety of reasons. Please give us an insight as to why you want to be a mentor in this program. Do you have any previous mentoring experience? Please detail Name of the Field of Period of Achievements Briefly describe the work done during Remunerations mentoring organization mentoring Self satisfaction the program Recognition Career Advancement Social Satisfaction Business lead and networking 5
    • What skills do you possess that will add value to the incubatees?1.2.3.4.5.How often do you want to mentor? Please specify the period.What days/ time you can devote for the WeeklyDaily mentorship program? MonthlyQuarterlyNumber of days in a week: Half yearly AnnuallyMonday Tuesday WednesdayThursday Friday Saturday 6Sunday Any dayDuration in terms of hours in a day: ____________________________________________
    • How do you want to provide service?Email/Chat Video conferencingWeb Casting Personal visitsGroup activities Blogs(E.g. Seminar, workshop etc)Others please specify________________How many free mentorship sessions you can offer? ________________________Type of incubatees you want to work with?Established StartupsInnovative Agri/RuralWoman Technology basedOther Please specify___________________How many concurrent incubatees you can work with? _________________________What are your expectations from the mentee? 7
    • Terms for program Financial terms: Please specify the fee for mentorship activity as per the mode of mentorship. 1. Phone: _______________________________________________________________________ 2. Personal Visits: ________________________________________________________________ 3. Webinars/ Videoconference: _____________________________________________________ 4. Email/Chat: ___________________________________________________________________ Time Duration: Please specify the time period you want to be engaged with the mentoring activity. 1 year 2 year 3 year 4 year 5 year More than 5 year Any other terms (financial or time period terms or both)ReferenceName :Designation :Phone No. :Address :Enclosures: 1. Photographs 2. Testimonials 8 3. Resume
    • DeclarationI hereby declare that the above information is correct and I am willing to take up this assignment and willdischarge all my responsibilities required thereof.Date: Signature of mentor 9