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Application form

The deadline for applications is Friday 17 February 2023 at 17.00.

It is vital that you attend all the sessions below so please hold them in your calendar. Confirmation of your participation will be sent after 17 February:

AHUA Mentor training, Thursday 16 March, 10.00 – 15.30, at Mills & Reeve’s offices, 24 King William St, London EC4R 9AT
Meet your Mentor session, online, Tuesday 21 March, 14.30 – 15.00
Mid point check-in session, online, Tuesday 5 September, 13.30 – 15.00.

AHUA Mentor Application Form

"*" indicates required fields

Personal Details

Title

First Name*

Last/ Family Name*

Preferred Name

Job Title*

Institution*

Email*

Phone*

Application questions

What would you like to achieve from participating in the AHUA reciprocal mentoring programme?*

What experience do you bring to the mentoring programme that you would like to share with others?*

As the scheme is Reciprocal, what do you particularly want to learn from participation in the programme, and from your Mentor?*

What do you particularly want to learn from participation in the programme?*

Briefly describe your experience of mentoring and supporting others in their development?*

How do you plan to implement your learning from the AHUA reciprocal mentoring programme within your own institution?*

Please provide a brief career biography (to support the mentor matching process).*

Diversity

Ethnicity*

Arab/Arab British

Asian/Asian British - Bangladeshi

Chinese/Chinese British

Asian/Asian British - Indian

Asian/Asian British - Pakistani

Asian/Asian British - Other

Black/Black British - African

Black/Black British - Caribbean 

Black/Black British - Other

Mixed - White and Asian

Mixed - White and Black African

Mixed - White and Black Caribbean

Mixed - Other

White - British

White - Gypsy/Traveller (including Roma)

White - Polish

White - Other (including non-British White identities)

Prefer not to answer

Other ethnic background

I don't know my ethnicity

Age*

20-29

30-39

40-49

50-59

60-69

Prefer not to say

Gender identity?*

Female

Male

Non-binary

Prefer to self-describe

Prefer not to answer

If you would prefer to self-describe your gender, please let us know in the comment box below

Confirmation*

I can confirm I can attend all the session dates as stated below:

AHUA Mentor training, Thursday 16 March, 10.00 – 15.30, at Mills & Reeve’s offices, 24 King William St, London EC4R 9AT
Meet your Mentor session, online, Tuesday 21 March, 14.30 – 15.00
Mid point check-in session, online, Tuesday 5 September, 13.30 – 15.00.

Signature*

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