Mentor application form

Our mentoring programmes

Contact details

Name

First name

Last name

Home address

Address line 1

Address line 2

City

County

Postcode / Zip code

Country

Phone

Email

Your interest in mentoring

Why are you interested in mentoring on our programmes?

Please outline your skills and experience and how you can support a student.

Please tell us more about yourself, in particular your interests and values.

Please tell us how you found out about our mentoring programmes.

Additional information

Name of current or most recent employer and job title

Are you a graduate of the University of Brighton?

YesNo

Date of birth (DD/MM/YYYY)

Gender (please note that the Men in Primary Education programme is open to male applicants only).

Ethnic origin

If you selected 'Black other' or 'Other' please specify.

Do you have any seen or unseen disabilities?

YesNoPrefer not to say

If 'Yes' please tell us how we can make the programme accessible to you.

Mentor declaration

Please tick to acknowledge that you have read and agree to abide by the following:

I agree to participate in induction and evaluation events, and to respond to all correspondence in a timely fashion.I agree to complete and return evaluation questionnaires when requested to do so.I accept that I have a responsibility to maintain regular contact with my mentee between in-person meetings, by phone, text or email.I agree to keep the Mentoring Co-ordinator informed of the progress of the mentoring relationship, in particular any difficulty with or breakdown of same.I agree to uphold equal opportunities in mentoring sessions.I agree to adhere to confidentiality in all instances, except where i) the health and safety of mentee, mentor or third party requires disclosure, ii) either party has grounds to believe there is a child or adult protection issue which requires it, iii) serious professional misconduct or criminal act by mentee or mentor comes to light in the mentoring relationship, iv) it is required by a court of law.

Signature

Date

Please make sure you read our privacy notice

Privacy notice

I understand and consent to how you will use my data

Mentor application form

Your application