STRIPES Mentorship Program Application

Welcome to the STRIPES Mentorship Program! Our program connects women in MedTech, from early-career professionals to seasoned leaders, fostering personal and professional growth. Whether you're seeking guidance or ready to share your expertise, this program is designed to create impactful, lasting relationships. Ready to take the next step? Complete the application below and join a vibrant community dedicated to advancing women in MedTech.

STRIPES Mentee Application Form, July - December 2025

First name*

Last name*

Email*

Phone*

Street Address*

City*

State*

Zip*

Professional Background

Current Job Title*

Company*

Years of Experience*

Industry/Specialty/Focus Area*

LinkedIn Profile URL*

Program Fee (please check the option closest to your current career level)*

Entry/In Transition$25

Specialist, Associate$50

Manager$100

Director$150

VP/Executive$250

Resume

Program Objectives:

Are you looking to gain guidance as a mentee or share your experience as a mentor?*

Mentee

Mentor

Both

If your primary purpose is to find a mentor, would you also consider mentoring someone more junior than you if needed?

Yes

Please outline your goals for participating in the STRIPES Mentorship Program?*

Please list your preferred mentor or mentee attributes here, such as expertise, specialty, experience level, location, or other specific qualifications and needs.*

Optional Details:

How did you hear about the STRIPES Mentorship Program?

Any additional comments or specific requests?

STRIPES Mentorship Commitment

By registering for the STRIPES Mentorship Program, I commit to fully participating as a mentor or mentee. I will:

Dedicate time to regular, meaningful meetings.
Respect my mentor/mentee's time, perspectives, and goals.
Maintain professionalism and confidentiality in all interactions.
Approach the relationship with an open mind and a willingness to learn or share.

I understand that this program is built on mutual respect, collaboration, and growth, and I commit to upholding these values.

Signature*

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