Brighton Effect Mentoring Application

Contact details

Name

First name

Last name

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.

What course did you study at Brighton?

Name of current or most recent employer and job title

What industry or field are you currently / have you most currently worked in?

Additional information

Date of birth (DD/MM/YYYY)

Gender

Ethinc 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

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I understand and consent to how you will use my data