Peer2peer Membership Form

This group aims to provide a forum for culturally diverse women in SET (UK) to share their experiences, discuss issues and work towards solutions for success and confidence in the work-place, in job searches and personal challenges. Open to anyone interested in cultural issues (**).

Please answer the starred questions and all others that you are comfortable with. Understanding cultural background helps us to achieve the aims of the group.(See also Questionnaire form)

Information will be kept on a MentorSET database and will be treated in the strictest confidence. No personal information will be given to external organisations without your permission.

You can download a copy of the questionnaire suitable for saving as a document for printing or completing off line:

• download Word version

Please send completed forms to: info@mentorset.org.uk. Or by post to: The Peer2peer Coordinator, c/o WES, Michael Faraday House, Six Hills Way, Stevenage, Herts, SG1 2AY

The * denotes required fields.

Contact Details

Title*
Surname / Family Name*
First / Given Name(s)*

Preferred Email Address*
Second Email Address

Home Telephone Number*
Work Telephone Number
Mobile Number

Address 1*
Address 2
Address 3
City/Town*
County
Post code

Personal Information

Date of birth	(DD) /(MM) /(YY)
Marital Status
Children (number)	Under 5 age 5-12 teenage
Ethnic origin*
Country of (Family) Origin
Were you born in the UK?	Yes No If no, length of time in the UK?
Reason for coming to the UK
Level of English
Religion
Any restrictions due to health / disabilities / transport / etc.

Professional Details

Are you a member of:*	WES IOP BCS Women@CL IOP-Women DJ Fellow BCS-Women Cambridge AWiSE None of these
Membership of other professional organisations
Employment Status* FT: Full Time, PT: Part Time	FT Employed PT Employed Self Employed Student Unemployed Career Break Retired Other If other, please specify
How long have you been unemployed or on a break?
Occupation / occupation to which you are hoping to return*
Job Title
Discipline*
Specific Area
Qualifications*
Where did you gain your qualifications?	College / City: Country:
Name of employer / establishment
Do you work in:*	Academia Industry Business Other If other, please specify
Sector, e.g. defence
Number of years worked
Brief description of your present position and responsibilities

Miscellaneous

Where did you hear about the Peer2peer group?
Any other relevant information
Would you like to find out more about MentorSET? (One-to-one mentoring for women in SET)	Yes, as a: Mentee Mentor No I am already a MentorSET mentor / mentee
Signature: (if you are submitting this form online, type in your name)*

Back to top

Peer2peer is sponsored by: