Mentor Application Form

Please complete all sections of the following form with as much detail as possible. The information from this form will be used to create a profile which students will view to help them select a mentor whose experience most closely matches their requirements. Your contact details will not be given to any students until a match has been made, at which point the email you have provided will be shared.

PLEASE NOTE: Fields marked are required to be filled in before the form can be submitted.

PERSONAL & CONTACT DETAILS
Title:   
First name:  
Last name:  
Contact address:  
Contact telephone no:  
Contact mobile no:
Contact email:  

APPLICATION DETAILS
PLEASE NOTE: The information you give in this section will be made available to approved mentees to help them select their mentor preferences.
Job title:  
Organisation name:  
Occupational sector: Please choose the Occupational Sector that you work in:
(ie the job role that you do, not what your organisation does)
  
Did you study at the University of Sheffield? No    Yes
 What was your course title and graduation year (UoS or other university)?:
Course title  
Year of graduation (most recent if more than one)
 
Brief description of your current role and organisation:
Please include the types of activities you do in your role eg desk work, project work, presentations, internal or external meetings etc
  
Brief history of your career to date:
Please list relevant job titles and organisations and any experience that has helped you get to your current position
  
What are the three things you love most about your job?  
Why are you interested in being a mentor, and what do you think you can bring to the role?  
Do you have access to Skype or any other online video input? No    Yes
How did you hear about the mentoring programme?

EQUAL OPPORTUNITIES (this section is for monitoring purposes only)
Gender: Male   Female   Other
Do you identify as LGBT*? Yes   No   Prefer not to say          * Lesbian, Gay, Bisexual or Trans*
Ethnic background:
Disability: Do you consider yourself to have a disability? No   Yes

Please tick which category you think best describes your condition and/or disability:
Dyslexia
Blind or partially sighted
Deaf or hearing impairment
Mental health difficulties
Mobility difficulties
Personal care support
Autistic spectrum disorder
Other condition(s) and/or disabilities (please specify)
     
Widening Participation to University: Would you have described yourself as a non-traditional entrant to University?
No   Yes

MENTOR DECLARATION TERMS & CONDITIONS
I wish to be considered as a volunteer for the Careers Service, a career-focused networking scheme offered to students from the University of Sheffield. I understand that my details will be kept within a 'pool' of mentors and participation on the scheme is dependant upon a suitable mentee being available.
If selected to participate in Careers Service Mentoring I will participate in accordance with the following Terms and Conditions:
(1) Should I meet students in my place of work I am responsible for making sure that the workplace is safe for the visit and that students are made aware of any risks or dangers on the premises
(2) I accept that the University of Sheffield and its staff accept no responsibility for any loss or damage to my personal property in connection with my participation in Careers Service Mentoring caused even if as a result of negligence by University of Sheffield, its staff or students.
(3) I agree to report to the Scheme Co-ordinator promptly any adverse incidents occurring during a meeting or visit arranged under the Scheme, including any incidents that might result in a legal claim for damages. The Scheme Co-ordinator can be contacted at: careermentoring@sheffield.ac.uk
(4) I understand that my data is stored securely and in accordance with the General Data Protection Regulation (GDPR) and will remain until I request it to be removed or I am no longer participating as a mentor. More information is available at https://www.sheffield.ac.uk/alumni/keepintouch/privacy
(5) I agree to maintain regular contact with my mentee, ie once a week, and to let the mentoring co-ordinator know if this is not possible.
(6) I agree to complete the mentoring evaluation form at the end of the scheme.
Tick box to accept