NHS Kent, Surrey and Sussex Leadership Academy

Mentoring Hub

Register as a mentee

To register as a mentee, please complete this form, filling in the requested information or ticking the boxes. The more information you provide, the easier it will be for us to match you to the right mentor.

To move between sections, click 'Next' or the required tab. When you have completed all sections, please click 'Submit my application now'.

nb. please do not use your browser's 'Back' and 'Forward' buttons, otherwise you may lose information that you have entered.

About you

Please tell us some details about yourself.

* denotes a required field

First name *
Last name *
E-mail address *
Organisation *
Job title *
Address line 1 *
Address line 2
Address line 3
Town *
County *
Postcode *
Telephone number *
Alternative telephone number

Mentee details

Please provide the following details specifically with regard to your mentee profile.

* denotes a required field

Roles / pay bands *
Any specific mentoring requirements

Matching preferences

Please indicate the offerings that you would be looking for from your mentor:

My current position *
I require a mentor to work with me to assist with *
I am willing to enter into a mentoring relationship that is *
I would prefer my mentor to be based within the following geographical area *
I would prefer my mentoring to take place via *

Diversity & Inclusion

The following questions are for D&I monitoring purposes only, and the information provided will not be made available to other users:

* denotes a required field

Your gender *
Your age group *
How would you describe your ethnic origin? *
Your religion or belief *
Please select the option which best describes your sexuality *
Do you consider yourself to be a disabled person as defined by the Equality Act 2010*
If you consider yourself to be a disabled person, and would like to, please indicate the nature of your disability (tick as many as are applicable)
Other disability - please specify

Mentoring agreement


CRBhub Coaching Hub is based on the CRBhub management system from CRB Associates