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Mentor Application Form 2025
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" indicates required fields
Personal Details
Title
First Name
*
Last/ Family Name
*
Preferred Name
Job Title
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Institution
*
Email
*
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 AHUA Mentor?
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How do you see the AHUA reciprocal mentoring programme supporting your career development and progression to a more senior role?
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Please provide a brief career biography (to support the mentor matching process) and your career aims.
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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
*
20-29
30-39
40-49
50-59
60-69
Prefer not 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
How did you find out about the Reciprocal Mentoring Programme?
Confirmation
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I can confirm I can attend all session dates as stated below:
Mentor training, Wednesday 29 January, half day, location TBA
Meet your AHUA Mentor session, February 2025
Mid point check-in session, 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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