Mentee – Expression of Interest Form

Application closing date: 1December 2017

To help us ensure you make the most of this mentoring programme, we need some information about you.

The information you provide will also assist us in matching you with an appropriate mentor.

Please answer these questions as fully and carefully as you can. There are no right or wrong answers. The questions are designed to make you think and to help the mentoring relationship be even more productive

Contact details:

Title:

Name:

Organisation:

Current position:

Faculty and Department:

Work Address:

Email address:

Telephone number which we may use to contact you:

What is your preferred method of contact?

Goals:

Why are you interested in being mentored now?

What are you looking to get out of the mentoring scheme?

What are your development goals for this programme (list the top three)?

What is most important* to you in a potential senior academic mentor?

 A discipline match?

 Overall experience in academia at senior levels?

*your response here will help inform the matching process, but ultimately is dependent on the availability of suitable mentors. Where possible we will endeavour to match you with a mentor from a partner institution – but cannot guarantee this.

Additional information:

How did you hear about the B-MEntor programme?

Is there anything else you would you like yourmentor to know about you (no more than 250 words)?

 I AGREE to familiarise myself with the induction dates for the January 2018 round, and undertake to attend one of the B-Mentor Mentee Induction Sessions on offer;

I AGREE to contact my institution’s B-MEntor project manager in the first instance if I have any questions, suggestions or concerns about the B-MEntor programme, my mentor, or any change in circumstances that may affect my ability to participate as a mentee for the year;

 I UNDERSTAND that pairing with a mentor will depend on the availability of suitable volunteers.

Data Protection Statement: By submitting your data you agree that it will be used by the B-MEntor project manager and partners to manage your participation in the above scheme. Your data will not be shared with any other organisations without your prior consent.

Please email your completed application form to:

Applications must be received by 1 December 2017

Many thanks for your help

Mentee Expression of Interest – updated September 2017