The Institute for Economic Empowerment of Women.

Title

Last Name (required)

First Name (required)

Middle Name

J-1 Visa require the location where the student will be living and working during the Mentorship. Please provide:

Home Address

Street (required)

City (required)

State (required)

Zip (required)

Business

Business Name (required)

Street (required)

City

State

Zip

Please list your phone numbers

Home Phone

Cell Phone

Work Phone

Fax Phone

Please Indicate Languages You Speak.

Speaking

Writing

Reading

Email Address (valid email required)

Mentorship is most meaningful when there is a match between the type and size of businesses. In order to make the best match between Mentors and Students, we would like the following informtion about your business.

Please describe, in detail, your business in 300 words or less.

How long have you had your business?

How many full time and part time employee do you have?

What percentage of your business do you own?

Annual Revenues

If in partnership, who are your partners?

In 300 words or less, please tell us why you are interested in this mentorship program.

Living with another family, and bringing someone into your home, can be a stressful time if an appropriate match is not made. Please take a minute to provide us with some information on you, your famlly (children, ages, pets, etc.) and how your family feels about participating in this program:

Realizing this is not a job interview, we would appreciate knowing more about your work history. Your entrepreneurial past will provide extra insight for making appropriate matches.

Do you have house pets?
---YesNo

Are there lifestyles or religions incompatible with yours?

Do you smoke cigarettes or use other forms of tobacco?
---YesNo

As you carefully consider participation in Mentorship, we ask that you are able to answer "yes" to the bulleted items below:

• Can you reasonably devote 5 days to a student from Afghanistan or Rwanda living and working with you? This will include such items as (but not limited to) teaching HR, business practices, management skills, other day-to-day business activities, as well as time normally spent with family and friends.
• Do you have private sleeping space available for a house guest?
• Are the members of your family agreeable to someone from another culture living with you as a honored member of your family?
• Are you willing to bear the additional financial burden imposed upon you as a result of a house guest. (gas, food, time, etc?)
• Though not mandatory for mentors, would you be willing to travel at your own expense to Dallas, TX for the International Women's Economic Summit?
• Are you willing to continue an open, on-going monthly e-mail correspondence with your student and IEEW for a year following your student's return home?

Raising funds to accomplish the good work that we are all involved with is challenging, especially in these trying economic times. Please let us know if you are able and willing to bear the cost of your student traveling to your city. If you live within driving distance of the International Women's Economic Summit in Dallas, perhaps you would be willing to drive your student back and forth. If you live outside of a driving perimeter, perhaps you would be willing to purchase a round trip ticket on Southwest Airlines. Regardless of your ability to assist with transportation, we look forward to your mentorship with these brilliant women!

IEEW does not encourage or endorse any participant business (both student or volunteer) and makes no guarantees of goods or services. IEEW acts only as the networking conduit. We are a 100% neutral position and can not become involved in brokering deals, requesting help or discounts.

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