Mentee Submission

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Preferred Name *

First Name

Last Name

Business Email *

(email domain must match that of registered DCAT Member Company)

Phone *

Geographic Location (Country/Region) *

Time Zone *

Company *

Job Title *

Years of Experience *

Which best describes your company’s primary focus? *

Which best describes your primary job function? *

If Other, please specify:

Briefly describe your current role and scope (2–3 sentences) *

What is your primary improvement goal for program? (Select up to 3) *

Communication skills
Negotiation skills
Industry knowledge development
Cross-functional leadership
Confidence building
Building a professional network
Effective self-advocacy
Decision making
Problem solving

Do you prefer your mentor to be within your same discipline? *

Yes
No
No preference

If preferred that the mentor is the same discipline, please select: *

Any restrictions, e.g., pairing of a mentor from a specific (competitor) company or area (e.g., any drug substance CDMO)? *

What type of guidance do you value most? (Select up to 2) *

Strategic advice
Skill-building/practice
Confidence-building
Sponsorship/advocacy

What mentoring style do you prefer? *

Direct and candid
Collaborative and reflective
Structured with goals

If there are more mentee applicants vs. mentors, would you be willing to be a mentor instead? *

Can you commit to the program (a minimum of 12-months duration with one 60-minute meeting a month)? *

Preferred meeting format: *

Video
Phone

Preferred meeting time window (business hours, evenings, flexible) *

What would success look like for you at the end of this mentoring program? *

ACKNOWLEDGEMENT: *

I agree to maintain confidentiality.
I acknowledge that the DCAT Alliance for Industry Women Pilot Mentorship Initiative is career-focused (not coaching, counseling or job placement).

Signature *

Clear Signature

DCAT is a not-for-profit business development association committed to providing learning experiences and industry activities that enhance knowledge and create opportunities for members to expand their network of customers and suppliers throughout the global Bio/Pharmaceutical business ecosystem.

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