Alumni Career Mentoring Scheme
Mentee Application Form

Part 1: Personal Details

1. / Name:
2. / Student Number:
3. / QUB email address:
(Note you should use this e-mail address only for the purposes of this scheme)
4. / School and degree subject:
5. / Year of study
6. / Activities and Interests.
Give details of any relevant activities and interests:

Part 2: Interest in Alumni Career Mentoring Scheme

7. / Please outline what you would hope to gain through the Alumni Mentoring Scheme:
8. / Please outline the career areas that interest you and why:
9. / Are you considering graduate employment options outside Northern Ireland?
Yes No Perhaps
10. / LIFE PLAN
How do/would you like to see your career developing in 5 years time?
11. / Communication, Commitment and Reliability:
a) Mentoring engagements take place over the phone and through e-mail and/or Skype (please note you should use your Queen’s e-mail only for this scheme). Are you able to access and use these forms of communication?

Prefer telephone and e-mail only Would like to use Skype, telephone & e-mail
b) Would you prefer a male or a female mentor?
Male Female No preference
c) What evidence have you attached in support of this application to further demonstrate your commitment to completing the mentoring session in full and being reliable in meeting any telephone and e-mail appointments?

My Personal Tutor has signed the statement below in support of my application
I confirm that I am the Personal Tutor of the applicant and that they have expressed a particular interest in completing all elements of the Alumni Career Mentoring scheme.
Personal Tutor name:
Personal Tutor electronic signature or contact e-mail:
Or other evidence (Please specify and attach to this form)
12. / Professional Career Guidance Disclaimer: The Queen’s Alumni Career Mentoring Scheme is to support you as you engage in your career planning and development and, while providing you with access to relevant career information, it does not constitute professional career guidance. To access this service please contact Careers, Employability and Skills on or go to the website at . If you decide to act upon any information or opportunity provided, it is your responsibility to check out all relevant details.
I understand that this scheme does not constitute professional career guidance
Yes No
CONFIDENTIALITY: I understand that all information shared between the mentor and mentee is confidential
Yes No
DATA PROMISE: DATA PROMISE: Queen’s University Belfast will process your personal data in accordance with the Data Protection Act 1998. All data is held securely by Careers Employability & Skills and will be treated confidentially. The information provided will be shared with the Development & Alumni Office as well as your mentor.
Your data may be used for communicating information related to the alumni career mentoring scheme, news or event invitations. It may also be used for a range of activities including the sending of publications, the promotion of benefits and services available, notification of alumni events in future and of programmes involving academic and administrative departments. Data may also be used in fundraising programmes and made available to our academic and administrative departments, unless you request otherwise.
Data will not be disclosed to external organisations, other than those acting as agents for the University on career or alumni-related projects. Under the terms of the Data Protection Act 1998 you have the right to object to the use of your data for the above purposes. If you wish to exercise this right, please notify us in writing detailing your objections.
I agree that my personal information can be shared, as stated above;
Yes No
Applicant Signature: / Date:
An electronic signature will be accepted for e-mailed applications

Please complete, sign and return this form:

By e-mail to / Or By submitting 2 hard copies of your application to;
Queen’s University Belfast,
Careers Employability and Skills (Alumni Mentoring Scheme)
Student Guidance Centre
University Road
Belfast
BT7 1NN

Further information can be found on