Mentor 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) *

Do you have prior experience with mentoring? *

If yes, how many years?

Please Share Details of your prior mentoring experience.

Please select all the areas you are comfortable with providing guidance to your mentee? (Select all that apply) *

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 and mentee to be within your same discipline? *

Yes
No
No preference

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

If there are more mentee applicants vs. mentors, would you be willing to mentee additional women? *

If so, how many mentees are you willing to support? *

How would you describe your mentoring style? *

Direct and candid
Collaborative and reflective
Structured with goals

What types of mentees do you work best with? *

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

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

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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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