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To help us ensure that you are matched with an appropriate mentee, we need some information about you. Please answer these questions as fully and carefully as you can. The questions are designed to encourage you to reflect on your current skills as a mentor and to facilitate a productive mentoring relationship.
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?
Experience and expertise offered:
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:
Have you been a mentor before? If so, please give details.
Why are you interested in being a mentor now?
What do you think you can bring in term of experience and expertise to a mentee (i.e. leadership skills, strategic planning skills, etc.?)
Mentor Expression of Interest – updated November 2014

Skills and Qualities:
Please rate yourself on a scale of 1 – 5 (1 = poorly developed, 5 = highly developed)
SKILL/QUALITY 1-5
Communication skills – verbal and non-verbal
Self-awareness
Empathising
Open-minded
Asking probing questions
Being objective
Being non-judgmental
Understanding different ways in which others like to learn/work
Problem solving
Decision making
Challenging
Confidence
Setting clear, realistic objectives
Giving/receiving positive constructive feedback
Additional information:
How did you hear about the B-MEntor programme?
Is there anything else you would you like your mentee to know about you (no more than 250 words)?
Would you be prepared to mentor more than one mentee?
 Yes
 No
 I AGREE to familiarise myself with the induction dates for the January 2015 round, and undertake to attend one of the B-Mentor Mentor 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 mentee, or any change in circumstances that may affect my ability to participate as a mentor for the year;
 I UNDERSTAND that pairing with a mentee will depend on the availability of suitable candidates.
Data Protection Statement : By submitting your data you agree that it will be used by the B-
MEntor 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
Mentor Expression of Interest – updated November 2014