WIN Mentor Form - Life Science Washington Institute

First Name*

Last Name*

Current Company

Email Address*

How did you hear about the WIN Program?*

Please provide a brief bio and include what you would like to bring to the WIN Mentoring Program.*

Industry Category: Please identify your industry experience(s), checking all that apply.

BioPharma (Biotechnology/Pharmaceutical)
Medical Technology (Devices/Diagnostics)
Health IT (Computation, patient/population data, wellness tracking, software, etc.)
Global Health
Other

If your industry is not listed, please provide a brief description of your industry/background.

Areas of Expertise: The WIN Mentoring Pool is comprised of professionals from a diverse background of experiences and expertise. Please check all areas in which you would be willing to provide mentoring.

If you selected other, or if there are additional areas of expertise, please describe below:

Thank you for your interest in participating in the WIN Mentoring Program!

Please email Aylin Kim, Manager of Entrepreneurship, with any questions.

WIN Mentor Interest Form