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Parliamentary Mentorship Program

Registration form for Women Mentors

Please note that information provided by Mentors will be available online through the Virtual Parliament on the Group of Women Parliamentarian’s Work Space. Access to this space is limited to registered parliamentarians and is not available to the general public.

PDF File
Personal Information

The fields marked with an asterisk * are mandatory.
Mrs. Ms. Miss *
First Name: *   Language of Preference: *  
Last Name: *  Languages Spoken :
Parliamentarian: *

Spanish Portuguese French English

Other :

Title: *  
Institution: *

Mailing Address : *



City: *   
State:   
Postal Code:

Country: *

Phone number (s) you can be reached at:*

(Include area code e.g: 613-555-5555)

Office: Cell.:
Home: Other:


Fax:

E-mail 1:

E-mail 2:

Website:

Number of years in elected office:

Mentorship Program

 

A) Which means of communications would you prefer using with the person you are mentoring?

E-Mail
Messenger (MSN, Yahoo, AOL ...)
Phone
Fax

Other:

B) Would you be interested in participating in/ travelling to a face to face meeting of mentors and mentored?

Yes
No

C) Would you be interested in contributing articles to the FIPA website and newsletter about your experience as women parliamentarian?

Yes
No

Are you interested in working with women from a particular country/region and, if so, where?

Experience and Interests

 

Should you require more space we invite you to send your résumés, biographies and CVs to us by e-mail at info@e-fipa.org

Committee experience:

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Date From - To


Positions held during your time in office:

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Date From - To


Professional, academic and volunteer experience:

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Date From - To

Personal areas of expertise and interest:
For more information contact:

FIPA Technical Secretariat, Canada, Tel: 1 (613) 594-5222, Fax: 1 (613) 594-4766, info@e-fipa.org

Should you have technical difficulties filling out this form, please contact : Technical support