Mentoring Application Form

A sense of fulfilment and purpose

Successful mentor-mentee relationships have numerous benefits for both parties. For the mentee, mentoring can provide access to new perspectives, knowledge, and skills. For the mentor, mentoring can be a rewarding experience that allows them to share their knowledge and expertise, and to give back to their community.

I am applying to participate in the role of:*

Mentor - to give Mentoring

Mentee - to receive Mentoring

First Name*

Last Name*

Email*

Phone*

Job Title*

Country*

We request that you complete this form as fully as possible. The information you provide will help us to match you with a mentee who has the development needs and preferences that match your skills and experiences.

1. Please give your permission for your personal details to be shared internally and confidentially with the PI Mentoring Committee.*

Yes, I give my permission for my details to be shared for the purposes of Mentoring only.

2. Are you prepared and do you have the capacity to commit a minimum of 6 hours over 8 months for this Mentoring programme?

Yes*

No

3. Please list the reason(s) why you want to experience Mentoring (either as a Mentor or Mentee).*

4. Please list the areas that you would like to offer or receive support in? List the interpersonal and business skills that you can offer as a Mentor; or that you find challenging as a Mentee.*

5. Please tell us a bit more about yourself to help us pair you with an appropriate Mentor/Mentee.*

6. Have you experienced Mentoring before?*

Yes

No

7. If yes, please tell us about your experience. What did the programme focus on, what worked well and what could have been improved?*

Applicant declaration

I acknowledge that any personal information supplied to PI is done so voluntarily to facilitate the processing of this application. I furthermore acknowledge that the information provided by me is to the best of my knowledge both true and correct, and I understand that any incorrect or inaccurate information or documentation submitted may adversely affect the manner in which PI processes my application to become a participant in a Mentoring programme.

Disclaimer

The information you are voluntarily providing will be used to help assist us in achieving our Mentorship programme goals for PI. The information collected will be used in accordance with GDPR and will only be shared with the PI Mentorship Committee.

Please tick the box below to accept the declaration and disclaimer as stated above.*

Date of Application*

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Mentoring Application Form