2024/2025 IHEA Mentoring Program
Intake Survey for Mentees

Please fill out this brief survey so the program can be better tailored to your needs and preferences.

1. Contact information

First Name *

Last Name *

Email Address used in your IHEA membership account *

No Email

Date of Birth * --

Institution *

Please list any other institutions at which you have studied or worked in the last few years

Country in which you are currently living and working/studying * []

Please indicate which country you identify with the most (may be your country of birth, origin or upbringing or the country in which you reside, etc.) * []

Highest Degree Completed *

If other:

Field of study of highest degree *

If other:

Year of graduation with highest degree: *

Security questions

I went to high school in the city: *

My first car was a: *

My favourite colour is: *

_{at least:
- 8 characters
- one upper case character
- one lower case character
- one number
- one special character (such as $!*)} Please create a password

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2024/2025 IHEA Mentoring ProgramIntake Survey for Mentees

1. Contact information

Security questions

2024/2025 IHEA Mentoring Program
Intake Survey for Mentees