Genesis

Personal Details

Full Name *

Email ID *

Mobile Number *

LinkedIn Profile URL

Professional Background

Current Role/Designation *

Company/Organization *

Years of Professional Experience *

Areas of Expertise (Select all that apply) *

Short Bio / Mentoring Philosophy (Max 200 words) *

Maximum 200 words

Mentorship Preferences

Preferred Mentorship Style *

One-on-one

Group Sessions

Both

Estimated Monthly Time Commitment (hours) *

Attach Resume/CV (Optional, PDF only)

Click to upload or drag and drop

PDF (max 10MB)

Declaration

I hereby declare that all the information provided above is true and correct to the best of my knowledge. I understand that my participation as a mentor is subject to review and approval by Genesis - QUIC.

I agree to the above declaration and terms & conditions *

Digital Signature *

Date *

Mentor Program Application