Old Dominion University Women’s Initiative Network (WIN) Mentee Application

Old Dominion University Women’s Initiative Network (WIN) Mentee Application

Thank you for your interest in the Women’s Initiative Network (WIN)! WIN is a mentoring program designed to support ODU students; traditional and nontraditional, including students who may be parents or caregivers as they pursue academic, professional, and personal success. WIN connects students with professional women leaders who offer guidance, support, and empowerment.
Please complete the application below. All information will be kept confidential and used solely for mentor matching and program planning.

Section I: Student Information
Name Name * First Last
UIN *
Email *
Phone Phone * - ### - ### ####
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
On Campus Address (If Applicable) On Campus Address (If Applicable)
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Major Program of Study *
Minor Program of Study
Anticipated Graduation Year *
Classification *

Classification Freshman Sophomore Junior Senior Graduate Student
Degree Pursuing *

Degree Pursuing Bachelors Masters Advanced Cert. Ph.D/Ed.d
Student Status: (Check all that apply)

Student Status: (Check all that apply) First-generation college student Nontraditional student Transfer student Parent/Caregiver Military-connected student International student
T-Shirt Size
Section II: Personal & Academic Insights
What are your academic goals for this year?
What personal or professional goals would you like support with? *

What personal or professional goals would you like support with? Time management Balancing school, work, or family Career exploration Graduate school preparation Building confidence/self-advocacy Networking and leadership Financial wellness Personal wellness/mental health support Other Other
List any extracurricular, work, family, or community commitments you currently have.
What are your hobbies, interests, or passions?
Section III: Mentorship Preferences
What qualities are most important to you in a mentor? (Select up to 3) *

What qualities are most important to you in a mentor? (Select up to 3) Supportive and encouraging Direct and honest Career-focused guidance Academic support Work-life balance understanding Experience in my field of study Personal development coaching
Are there any specific identities or lived experiences you prefer your mentor to share?
(This helps us with thoughtful matching and is completely optional.)
When are you most available to meet with your mentor? (Check all that apply)

Weekdays *

When are you most available to meet with your mentor? (Check all that apply)

Weekdays Early Morning (7:00 AM – 9:00 AM) Late Morning (9:00 AM – 12:00 PM) Early Afternoon (12:00 PM – 3:00 PM) Late Afternoon (3:00 PM – 6:00 PM) Evening (6:00 PM – 8:30 PM) Late Evening (after 8:30 PM)
Weekends *

Weekends Saturday Morning Saturday Afternoon Saturday Evening Sunday Morning Sunday Afternoon Sunday Evening
Preferred Meeting Format *

Preferred Meeting Format In-person Zoom/Virtual Phone Hybrid / Flexible
Section IV: Short Answer Questions

Please respond to each question in 3–5 sentences.
Why do you want to join the WIN mentoring program?
What career sectors and jobs are you interested in? What is your career goal after graduation?
What do you hope to gain from your mentor through this experience?
What strengths, qualities, or unique perspectives will you bring to the WIN community?
Section V: Support & Accommodations (Optional)
WIN welcomes students with diverse life experiences. Please share any needs that may help us support you better (childcare considerations, accessibility needs, preferred meeting formats, etc.).
Section VI: General Photo and Media Release
By submitting this application, I hereby grant Old Dominion University (ODU), the Women’s Initiative Network (WIN), and their authorized representatives permission to photograph, record, or capture my likeness, image, voice, or written statements during program activities and events. I understand that these materials may be used for educational, promotional, or informational purposes—including but not limited to websites, social media, printed materials, presentations, or reports.

I understand that:

My participation is voluntary and I may decline to be photographed at any time by notifying the event organizer.

No compensation will be provided for the use of these materials.

ODU and WIN will use my image responsibly and will not use photos or recordings in ways that misrepresent my participation.

By completing this application, I acknowledge that I have read and understand this release and consent to the use of my image and/or recorded likeness as described above. *

By submitting this application, I hereby grant Old Dominion University (ODU), the Women’s Initiative Network (WIN), and their authorized representatives permission to photograph, record, or capture my likeness, image, voice, or written statements during program activities and events. I understand that these materials may be used for educational, promotional, or informational purposes—including but not limited to websites, social media, printed materials, presentations, or reports.

I understand that:

My participation is voluntary and I may decline to be photographed at any time by notifying the event organizer.

No compensation will be provided for the use of these materials.

ODU and WIN will use my image responsibly and will not use photos or recordings in ways that misrepresent my participation.

By completing this application, I acknowledge that I have read and understand this release and consent to the use of my image and/or recorded likeness as described above. I agree to the Photo & Media Release I do not agree to the Photo & Media Release
Section VII: Agreement & Commitment

By submitting this application, I acknowledge that if selected, I agree to:
- Participate actively in the WIN mentorship program.
- Attend scheduled meetings and meet with my mentor at least once per month.
- Communicate promptly (within 24 hours) when my mentor reaches out.
- Come prepared for meetings with goals, questions, or updates.
- Respect professional boundaries, including confidentiality limits as outlined in the WIN Mentee Guide.
- Understand that mentors cannot provide financial support, housing, or mental health counseling.
- Use ODU mental health and safety resources when appropriate.

By digitally signing below, I confirm that the information I’ve shared is true and complete. I understand what is expected of me as a WIN mentee and commit to showing up, communicating consistently, and engaging fully in the mentoring experience.
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.