MENTOR-VIP application form

How did you learn about the MENTOR-VIP programme?

Family name

First name

Date of birth

Current title

Mailing address

Country

Telephone number

Email address

In what country do you expect to be residing during the period of September this year to September next year? Please note you are NOT being asked to indicate a country to which you would like to travel to undertake a mentorship. MENTOR-VIP will not financially support activities related to mentoring, including travel of mentors or mentees.

Are you open to your mentor residing in a different country?

Preferred language for the mentorship

Another language in which you would be prepared to communicate with your mentor (if applicable)

Please list your three most important academic qualifications, one per line, each with the year in which the qualification was obtained

Are you currently employed by or officially affiliated with an institution?

Name of institution

Mailing address of institution

Country

In approximately 500 words, discuss your major achievements to date in the violence and/or injury prevention field

If you have published in the peer-reviewed literature on a violence or injury topic, provide the references for what you feel are your five most significant papers (one per line).

Referring to the skill categories of MENTOR-VIP, select the skill category you feel you most want to develop.

Referring to the skill categories of MENTOR-VIP, select the skill category you feel is of second most importance for you to develop.

Referring to the skill categories of MENTOR-VIP, select the skill category you feel is of third most importance for you to develop.

Based on your knowledge of MENTOR-VIP, describe in approximately 500 words why you feel you should receive a mentorship and what you feel this mentorship could provide you with in terms of skills development.

Different people have different needs. In approximately 500 words describe your expectations of a mentorship if your application is successful. In your answer clarify your expectations with regard to the following issues: time commitment to the mentorship; level of support and mentoring you feel you need; how the mentorship would complement any forms of support locally available to you; any other issues you feel are relevant to your expectations of a mentorship.

MENTOR-VIP Mentorship application form

Applications for MENTOR-VIP are now closed. They will reopen on this page on 2 February 2026.