Mentor application form

Please specify the programme(s) you wish to work with
Identity MatchLGBTQ+ Uni:AmexMen in Primary EducationMomentumRecruitment Ready Mentoring
Are you a 小黄书 graduate?
YesNo

Your details
Name

First name

Last name
Date of birth (DD/MM/YYYY)
Home address

Address line 1

Address line 2

City

County

Postcode / Zip code

Country
Email address
Telephone number
What gender do you identify as?
How would you describe your ethnicity?
If you selected 'Black other' or 'Other' please specify.
Do you have any seen or unseen disabilities?
YesNoPrefer not to say
If you answered 'yes' please specify and outline ways in which we can make the programme accessible to you.

Your interest in mentoring
Please tell us why are you interested in mentoring on our programme? Max 150 words
Please tell us more about yourself, in particular your interests and values Max 250 words
Student mentees will identify the goals they would like to work on with their mentor. Please select any of the following areas that you feel able to support a student mentee with
Interview techniquesNetworking and building relationshipsCV and cover lettersConfidence buildingBalancing work, study and lifeExploring the job marketEffective planning to achieve deadlinesSettling in the UKUnderstanding what is expected in a work environmentPresenting and public speaking
Other
Student mentees will be studying one of the following course areas. Please select any area where you have knowledge and/or experience:
Applied Sciences: Geography, Environmental, Biomedical and Pharmacy, Town PlanningArchitecture, Technology, Engineering: Architecture and Interior Design, User Experience and Games Design, Engineering, Construction, Quantity Surveying and Project ManagementArt and Media: Journalism, Media Studies, Fine Art and Illustration, Graphic Design, PhotographyBusiness and Law: Law, Accounting and Finance, Business Management and Economics, MarketingEducation, Health and Sport Sciences: Education, Physiotherapy, Occupational Therapy, Nursing, Podiatry, Health Promotion, SportHumanities and Social Sciences: Politics, International Relations and Globalisation, Social Work, Counselling, Psychology, Criminology and Sociology, English Language, Literature and Creative Writing, HistoryMedicine: Clinical Education, Medical Education, Medical Research, Psychiatry
Please give brief information about your knowledge/experience in the areas you have identified above
Name of current or most recent employer or business and job title
What is your current employment status?

Mentor declaration
Please tick to acknowledge that you have read and agree to abide by the following:
I agree to attend an induction and training session.I agree to complete feedback questionnaires when asked to do so.I agree to fully engage with the Mentoring programme, regularly meeting with my mentee.I agree that I will keep in contact with the Mentoring Team throughout the programme.
Signature (full name)
Date (DD/MM/YYYY)
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Privacy notice
I understand and consent to how you will use my data

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Mentor application form

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