What is your name ?
What is your surname ?
Cellphone:
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Age: 18-24 25-29 30-34 35-39 40-49 49 and older
Province: Eastern Cape Free State Gauteng KwaZulu-Natal Limpopo Mpumalanga Northern Cape Western Cape
Country:
What is your scientific discipline ?
Last obtained academic qualification: Post PhD PhD Masters Honours Bachelors Diploma
Share your own experience of being mentored for relatability:
Describe your ideal mentee ( stipulate any prerequisites of your ideal mentee):
How much time can you dedicate to the mentorship program in a week ? 2-5 hours 5-10 hours 10-15 hours more than 15 hours