MentorSET Application Form

How to apply

If you would like to apply to be a mentor or mentee, please complete the questionnaire below. You need not answer all the questions if you don't want to, but the more information we have, the better our matching will be.

Note that at this stage of the project, mentees must be a member of either WES, or a member of an organisation which has company membership such as CamAWiSE, IOP womens group, DJ Trust Fellow, Women@cl or BCSwomen. If you are not now a member, please check out the information and links on the WES page. We hope you will want to join for much more than just the mentoring scheme! Mentees must also be resident in the UK.

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

download Word version

Information provided will be kept confidentially on a MentorSET / UKRC (MentorSET's sponsors) database. By applying, you are agreeing to this.

Any questions? Email info@mentorset.org.uk

How Much Does It Cost?

The MentorSET scheme is currently FREE to both Mentors and Mentees. Mentors' expenses will be paid. For mentees, some expenses (travel etc) may be met by the scheme.

The * denotes required fields.

Questionnaire

Contact Details

Title*
Surname*
First Name(s)*
Date of Birth	(DD) /(MM) /(YY)

Home Telephone Number*
Work Telephone Number
Mobile Number

Preferred Email Address*
Second Email Address

Address 1*
Address 2
Address 3
City/Town*
County
Post code
Select your country

Professional Details

Are you member of WES, AWiSE, IOP, BCSwomen, women@cl, RESNET or a Daphne Jackson Fellow? Please list all applicable:*
Membership of other professional organisations
Employment Status*	Employed Unemployed Career Break Retired Other If other, please specify
Occupation / occupation to which you are hoping to return*
Job Title
Discipline*
Specific Area
Qualifications*
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
Explain any restrictions on who you could pair with, e.g. business (list relevant companies)

Questions for Mentors:

Reasons for seeking a mentee*
Have you been a mentor before?	Yes No
Do you have life skills, knowledge or experience which would be helpful to mentees?
Have you returned to your career after a break? Successfully?
Have you experience of balancing work/home responsibilities? Please give details.
Have you disabilities or health problems? If so, do you feel you could share your experiences with others?
Other information that may help during the matching process, e.g. Have you ever been unemployed? Would you be willing to help someone who is unemployed?

Please give the names and work telephone numbers and addresses of two referees (work if possible)

Referee 1:
Name
Address 1
Address 2
Address 3
Address 4
Post Code
Telephone Number
Email Address

Referee 2:
Name
Address 1
Address 2
Address 3
Address 4
Post Code
Telephone Number
Email Address

Miscellaneous

Where did you hear about MentorSET?

Your Marital Status	Married Living with Partner Single Divorced Separated Widow Other If other, please specify
Ethnic origin
Information about Children	None Dependent Independent (tick if all your children are independent)
Do you want to be a mentor, mentee or both?*	Mentor Mentee Both
In which areas of the country could you meet your mentor/ mentee? (e.g. within 50 miles of Manchester or London and South East etc.)
Give details of restrictions due to lack of transport / disabilities.

Keyword 1
Keyword 2
Keyword 3
Keyword 4
Keyword 5

Are you looking for a long term relationship with the mentor or a quick boost?	Long Medium Short
How important to you are face to face meetings (after an initial meeting)?	Very important, I hope to meet regularly I would like to meet occasionally but also intend to use the telephone and emails. Not important. After the initial meeting, I am happy to use emails and the telephone
Have you returned or are you hoping to return after a career break	Just returned after a career break Returned after a career break, when? Hoping to return No career break
Other information that you would like us to consider during the matching process, e.g.Carer of the elderly, Step parent, Parent of child with special needs.