Tawjeeh Mentee Form 2026

Full Name *

Gender
MaleFemale

Date of Birth *


Student ID *


Department/Program *

KU Email Address*

Personal Email Address*

Contact Number *

Nationality
—Please choose an option—

City *
Abu DhabiDubaiSharjahAjmanUmm Al QuwainRas Al KhaimahFujairah

Year of Study *

Year3Year4

CGPA *

Areas of Interest (Choose at least 2) *
Healthy LongevityCancer BiologyInfectious diseasesMolecular Biology and GeneticsPrecision MedicineBiostatistics and BioinformaticsDigital HealthRegenerative Medicine and Stem Cell ResearchDrug Discovery and TherapeuticsPublic and Environmental Health

If you are a 4th-year student, which semester are you currently in?*

FallSpringSummer

How did you hear about the Mentoring Program? *
University email or newsletterFaculty member or academic advisorKU Tawjeeh Mentorship Program WebsiteSocial media (Instagram, LinkedIn, etc.)

First choice mentor *
Irene ParkKhadija AminWael OthmanDr. Okobi EkpoAnna Maria PappaKartik Carlo Ranga RajZakia DimassiDr. Thanumol Abdul KhaderMuhammad Farooq RaiMira MousaSarah Chehadeh

Second choice mentor *
Irene ParkKhadija AminWael OthmanDr. Okobi EkpoAnna Maria PappaKartik Carlo Ranga RajZakia DimassiDr. Thanumol Abdul KhaderMuhammad Farooq RaiMira MousaSarah Chehadeh

Third choice mentor *
Irene ParkKhadija AminWael OthmanDr. Okobi EkpoAnna Maria PappaKartik Carlo Ranga RajZakia DimassiDr. Thanumol Abdul KhaderMuhammad Farooq RaiMira MousaSarah Chehadeh

Academic CV *

Attachments
The Mentorship Program will run for a full academic year. *
I am available to commit to the Mentorship Program for the full duration.
YesNo