Your Details Title: First name:* Last name:* Gender: Female Male Not specified Date of birth:* Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Email:* Phone: Country of residence:* City:* Languages You Speak Native language*: Add any additional language(s) you speak fluently: Please list all languages indicating your level of proficienty. (“N” for native or near-native, “FL” for fluent, “IM” for intermediate). Education Tertiary degree(s): Please specify type (e.g., MS, PhD), subject, institution, and year for each tertiary degree.* Please list any other relevant certifications or qualifications. Professional Experience Current position:* Current institution:* Please briefly describe what you do (including your regular professional activities):* Please provide any public links to your professional webpage(s) (e.g., your personal university page, your Google Scholar profile, your ResearchGate profile, etc.): STEMM Expertise Please select your primary STEMM area of expertise. If you consider your area to be interdisciplinary, please check all options that apply.* Biological and biomedical sciences (e.g., medical sciences) Computer and information sciences Engineering Mathematics and statistics Physical sciences (e.g., physics, chemistry, astronomy, earth sciences) Other Please describe your specific area(s) of STEMM expertise (e.g., quantum physics, artificial intelligence).* Please list the keywords about your STEMM research and/or R&D work.* Please provide a listing and/or a public link to your research publications/patents/inventions.* Please list a few of your most important professional achievements:* Please indicate name, year, and, if possible, a link to a public website where these achievements have been published. (e.g., key publications, patents, awards). Mentoring Experience Have you ever mentored someone?* —Please choose an option— Yes No Please provide details. Please indicate the year, duration, age group of your mentee(s), number of your mentee(s), and field(s) of mentoring.* Why do you want to volunteer as a mentor for Global Talent Mentoring?* In what main area(s) in STEMM would you like to mentor a mentee? (Please select max. 3 areas)* Astronomy Biological and biomedical sciences (e.g., medical sciences) Chemistry Computer and information sciences Earth sciences Engineering Mathematics and statistics Physics Other Please list any further knowledge, competency, and skill that can be potentially relevant in mentoring a STEMM student: Professional References Please list the names of people you are working with (e.g., in your department) whom we may contact as references. Please indicate their name, institution, job position, their relation to you, the duration you have worked with them, and an email address where we may contact them.* Data and Security How did you learn about Global Talent Mentoring?* —Please choose an option— Academic Talent Development Program, UC Berkeley (ATDP) Advanced Material Pandemic and Future Preparedness Taskforce (AMPT) Aerospace and Electronic Systems Society (AESS) Agilent American Association for Anatomy American Society of Agricultural and Biological Engineers (ASABE) American Society for Engineering Education (ASEE) appliedAI Applied Science and Technology Research Institute, Hong Kong (ASTRI) Arabian Gulf University (Bahrain) AraCreate Associação Nacional para o Estudo e Intervenção na Sobredotação - ANEIS (Portugal) Association for Technical Culture of Slovenia (ZOTKS) Astra (Denmark) Axcelis Technologies BASF SE Belgian Women in Science Biochemical Engineering Community Assistance Project (BECAP, Colombia) Bulgarian Ministry of Education and Science Cape Coast Technical University (Ghana) Caribbean Centre for Giftedness and Creativity Center for Gifted Education at the College of William and Mary Center for Talented Youth Greece (CTY Greece) Centre Corporate Social Responsibility Development, Ukraine (CSR Ukraine) Centre for Talented Youth Ireland (CTY Ireland) Chemistry Industry Association of Canada (CIAC) Colombian College of Neurosciences (COLNE) Croucher Foundation CyberMentor Danish Microbiological Society Delhi Private School Sharjah Diocesan School for Girls (New Zealand) Dr. Kalmadi Shamarao Junior College (Kaveri Group of Institutes) DreamSpace Academy (Sri Lanka) European Talent Support Network (ETSN) Fazekas Mihály Secondary School Fédération Européenne d'Associations Nationales d'Ingénieurs (FEANI) Florida Atlantic University Foundation for Research and Technology — Hellas (FORTH) Fundación STEM sin Fronteras (Colombia) Future Minds (Peru) Genetics Society of America Gesellschaft Deutscher Chemiker (GDCh) Gifted Education (New Zealand) Green School, Bali (Indonesia) Hamdan Foundation Hong Kong Academy for Gifted Education Limited (HKAGE) ICB Institute of Computational Biology (Helmholtz Zentrum München) Illinois Mathematics and Science Academy (IMSA) IUBH University of Applied Sciences Jubilee Institute (Jordan) Junior Academy of Sciences of Ukraine (JAS) Kaunas University of Technology (Lithuania) KI Bundesverband Koninklijk Instituut Van Ingenieurs/Royal Netherlands Society of Engineers - KIVI Komm, mach MINT Kotebe Metropolitan University Kumasi Technical University LTER-Austria - Austrian Society for Long-term Ecological Research Maharaja Sayajirao University of Baroda Marie Curie Alumni Association (MCAA) Mount Kenya University Mully Children's Family National Pedagogical Institute of the Czech Republic Northwestern University, Center for Talented Development NYU Abu Dhabi (UAE) Ordem dos Engenheiros (Portugal) PASCO Scientific Platform Talent voor Technologie (Dutch National STEM Platform) Radboud University Sabah Al Ahmad Center for Giftedness and Creativity (SACGC) (Kuwait) Seoul National University (South Korea) Science Communication Hub Nigeria (Nigeria) School of Education, UC Berkeley (United States) St. Martin's College (Malta) Sukkur IBA University, Executive Development Center Taipei Resource Center for the Gifted and Talented (TRCGT) Tamale Technical University The Ohio State University Triplebar University of British Columbia University of Iowa, Belin-Blank Center for Gifted Education and Talent Development University of Management and Technology University of Vienna (Faculty of Earth Sciences, Geography and Astronomy) University of Wollongong University Transition Program, University of British Columbia VBIO Verband Biologie, Biowissenschaften und Biomedizin e.V. Other I permit Global Talent Mentoring to share the information I submit in the Mentor Volunteer Form to my nominating institution (as selected above).* I consent to the storing and processing of my data by Global Talent Mentoring.* I will provide further information as requested by Global Talent Mentoring prior to participating in the program.* Do you have a criminal record?* No Yes
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