Suffolk Coaching and Mentoring Partnership

Register as a mentor

To register as a mentor, please complete this form, filling in the requested information or ticking the boxes. The more information you provide, the easier it will be for the right people to find your profile.

To move between sections, click 'Next' or the required tab. When you have completed all sections, please click 'Submit my application now'.

nb. please do not use your browser's 'Back' and 'Forward' buttons, otherwise you may lose information that you have entered.

About you

Please tell us some details about yourself.

* denotes a required field

Title  
First name *
Last name *
Job title *
Organisation *
Sub-organisation
Organisation address *


Town *
County / region *
Postcode *
Telephone number *
Alternative telephone number
Preferred e-mail address *
  *
Consent to storage and use of your personal data *

Objectives

Please tell us what you are hoping to achieve from your mentoring.

* denotes a required field

Level(s) of staff to whom you are happy to provide mentoring: (please tick all that apply) *




I have experience in and am willing to work with someone to help them: (please tick all that apply) *






Logistics

Please tell us how you would prefer your mentoring to work in practice.

* denotes a required field

I am willing to enter into a mentoring relationship that is: (please tick all that apply) *

I am willing to work within the following geographical area: *





I would prefer my mentoring to take place via: *
Mentoring experience *
Any other useful information
Number of mentoring relationships I am willing to have at any one time *

Equality monitoring

The following questions are for equality monitoring purposes only, and the information provided will not be made available to other users:

Are you: *

What is your age group? *


What is your ethnic group? *















Please indicate your religion or belief *








Please indicate which term would best describe your sexual orientation *



Do you have a disability? *
A disabled person is defined in the Disability Discrimination Act as someone with a physical or mental impairment that has a substantial and long term impact on their ability to carry out day-to-day activities

If you answered yes, and would like to, please indicate the nature of your disability (tick as many as are applicable)








Other, please specify:  

 

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