Mentee – Expression of Interest Form
APPLICATION CLOSING DATE: 11th December 2015
To help us ensure you make the most of this mentoring programme, we need some information
about you.
The information you provide will also assist us in matching you with an appropriate mentor.
Please answer these questions as fully and carefully as you can. There are no right or wrong answers.
The questions are designed to make you think and to help the mentoring relationship be even more
productive
Contact details:
Title:
Name:
Organisation:
Current position:
Address:
Email address:
Telephone number which we may use to contact you:
What is your preferred method of contact?
Goals:
Please clearly state your discipline area and summarise your main professional interests and
experience to date. This should be no more than 250 words. This information is key to facilitating the
matching process:
Why are you interested in being mentored now?
What are you looking to get out of the mentoring scheme?
What are your development goals for this programme (list the top three)?
What is most important* to you in a potential senior academic mentor?
 A discipline match?
 Overall experience in academia at senior levels
*your response here will help inform the matching process, but ultimately is dependent on the availability of
suitable mentors
Mentee Expression of Interest – updated November 2014
Mentee – Expression of Interest Form
Additional information:
How did you hear about the B-MEntor programme?
Is there anything else you would you like your mentor to know about you (no more than 250
words)?
 I AGREE to familiarise myself with the induction dates for the January 2015 round, and undertake
to attend one of the B-Mentor Mentee Induction Sessions on offer;
 I AGREE to contact my institution’s B-MEntor project manager in the first instance if I have any
questions, suggestions or concerns about the B-MEntor programme, my mentor, or any change in
circumstances that may affect my ability to participate as a mentee for the year;
 I UNDERSTAND that pairing with a mentor will depend on the availability of suitable volunteers.
Data Protection Statement: By submitting your data you agree that it will be used by the BMEntor project manager and partners to manage your participation in the above scheme. Your data
will not be shared with any other organisations without your prior consent.
Please email your completed application form to: equalities@ucl.ac.uk
Applications must be received by 11 December 2015
Many thanks for your help
Mentee Expression of Interest – updated November 2014