Online form: Request to join the scheme as a mentor

SECTION 1: About you

Name:

Position and institution:

Brief synopsis of employment history:

Email address:

Phone number:

Address for correspondence:

Please answer the following questions so that we can match you up with a mentee who expresses the relevant preferences:

Gender:

Main area(s) of research:

Age:

Family responsibilities:

SECTION 2: Further information

If you have any preferences (e.g. you would prefer not to have any face-to-face meetings - though note that the mentee, and not the mentor, would be expected to do the travelling), or wish to provide any other information, please tell us here. It would also help us if you could say briefly why you would like to join the scheme as a mentor.

FORM SUBMISSION

It is recommended that you print this form out before submitting it.

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