Application form - Mentor

Personal details
Title	Mr Ms Miss Mrs
First name
Family name
Address (h)
Telephone number (h)
E-mail address
Employment details
Organisation
Address
Telephone number (w) [incl area code]
What sector would you describe this as
Position title
Brief (under 50 words) description of your job
Background
Please describe for us briefly your library experience: type of library and work experience - (any experience acquired during fieldwork placements should be indentified)
What do you hope to gain from this mentoring program?
Skills and strengths please tick those areas which you feel you would be able to mentor someone in
Technical services	Cataloguing Acquisitions Systems Online/Digital IT applications
Client Services	Reference Collection development Information literacy Knowledge management Training
Management	General management Human resources Financial management Project management Team management Leadership
Other	Problem-solving General professional development Research
Please indicate any other areas of interest not covered
Your mentoree
If you have previously been enrolled in this programme, do you want to be matched with a new mentoree?	Yes No
Would you be happy accepting a mentoree that lives remote from you?	Yes No
Would you prefer a mentoree working in a similar sector to yourself?	Yes No
Do you have a particular preference regarding a possible mentoree (gender, level of experience, geographic location, etc)	Yes No

How do we use the data that you enter into this form?
Check our privacy statement.