Mentor Application Form

First Name

Surname

Date of Birth

Gender

Male

Female

Other

Email address

All further communication will be via email

Mobile Number

Home Address

City

State / Province

Zip / Post Code

Country

Additional Information

Employer

Position

Work Address

City

State / Province

Zip / Post Code

Country

Why do you want to become a mentor and how do your experiences reflect that?

1600 characters max – approx. 250 words

What do you think makes a good mentor?

(1000 characters max – approx. 150 words)

What do you love doing and why?

(1000 characters max – approx. 150 words)

If we were unable to match you with a mentee, would you be interested in other volunteer opportunities with the Inspiring Leadership Trust?

Yes, please keep me updated

No, thanks

Personal reference

Please provide the name, email and phone number details from one friend or family member

Work reference

Please provide the name, email and phone number details of one of your current or past colleagues

Do you currently hold a valid DBS certification?

Yes

No

Have you previously been DBS checked?

Yes

No

When would you be able to start mentoring?

Fundraising – we like our mentors to help fundraise during the year. Would you be happy to do this?

Yes

No

Any other comments?

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