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AHUA Mentor Application Form 2025
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" indicates required fields
Personal Details
I can confirm I am an AHUA Member
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Yes
If you are not a member of the AHUA, please fill out the Mentor form on the Reciprocal Mentoring Programme webpage.
Title
First Name
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Last/ Family Name
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Preferred Name
Job Title
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Institution
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Email
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Phone
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Application questions
What would you like to achieve from participating in the AHUA reciprocal mentoring programme?
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What experience do you bring to the mentoring programme that you would like to share with others?
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As the scheme is Reciprocal, what do you particularly want to learn from participation in the programme, and from your Mentor?
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What do you particularly want to learn from participation in the programme?
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Briefly describe your experience of mentoring and supporting others in their development?
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How do you plan to implement your learning from the AHUA reciprocal mentoring programme within your own institution?
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Please provide a brief career biography (to support the mentor matching process).
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Diversity
Ethnicity
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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
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20-29
30-39
40-49
50-59
60-69
Prefer not to say
Gender identity?
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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
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I can confirm I can attend all the session dates as stated below:
AHUA Mentor training, Thursday 30th January 2025, full day, location TBA
Meet your Mentor session, online, February 2025
Mid point check-in session, online, June 2025
Cancellations and Data Protection
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Cancellations:
• All cancellations must be made in writing (post or email) to the AHUA.
• The AHUA will not be responsible for any expense incurred in the lead up to the event. Should the event be cancelled the AHUA will not reimburse for any expense incurred.
• Please visit the AHUA website for the full Terms and Conditions including the cancellation policy.
• Please contact info@ahua.ac.uk to cancel your place on the programme.
Please indicate that you agree to the AHUA storing your booking details electronically in order: to process your application; to invoice; to send you information about this Programme including a list of delegates with their email addresses; and for statistical purposes. Your information will not be used for any other purpose nor shared with third parties outside the Programme participants.
I agree to the above.
Signature
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