Tick which Scheme you are interested in: / Admin Focus / Technical Focus
Personal Details
Forename
/
Surname
/
Title
Job Title
/ Grade
University
Address
Email
Work Telephone
Career Path/Experience
What do you enjoy most about your role in the University?
What do you consider are the challenges/issues you are facing while trying to progress in the organisation? And how do you see mentoring helping you to overcome this?
Please describe your ideal mentor? (skills, area of work, experience, etc)
What do you hope to get out of being involved in theMentoring Programme?
The minimum requirement for meetings is to meet your mentor for 3 meetings over a 12 month period (approx 1.5 hrs per meeting). Can you commit to this time?
 Yes No
When would you prefer to meet yourmentor? Please tick as many as apply
 Weekday morning  Weekday afternoon  Weekday evening  Anytime
If part-time, which days of the week do you work?
Mon Tues Weds Thurs Fri
Which of these mentoring approaches would you like to be involved with?
Mentee in a mentoring pair (one to one)
Mentee in a mentoring circle (one mentor to 3 mentees for peer mentoring) 
I don’t mind 
Please let us know any other information which you feel may be useful when matching you with a mentor.
MENTEE TRAINING WORKSHOPS (compulsory for new applicants to the programme)
Please indicate below if you are able to attend the mentee training session on:
Wednesday, 9 October 2013 @ 1:00-3:00
Wednesday, 16 October 2013 @ 2:00-4:00

Expectations

  • I understand that I will be a mentee with one mentor assigned to me. I will work towards setting and reaching my personal and career goals. I will be available and accessible to my mentor within reason.
  • I understand that providing regular, prompt and meaningful feedback about my mentoring relationship to the Mentoring Programme team is an essential component of the programme. If I feel uncomfortable or overwhelmed by any situation, I will contact the Mentoring Programme team for assistance.
  • If for any reason I wish to withdraw from participating in the Mentoring Programme I will contact the Mentoring Co-ordinators at ) to discuss my reasons. They will inform my mentor.
  • I understand that my application form will be shared with my mentor.

I confirm that the details contained within this form are correct and give my permission for this information to be shared with my mentor.

Signature______

Date ______

Please return this application form by email to:

We may contact you via telephone/email to discuss your form in further detail.

c:\documents and settings\uos\desktop\dropbox\mentoring\2013_14\mentee_application_form_june_2013_lah.docx