Mentoring Hub : NHS South West

About you
Mentor details
Mentee details
Diversity & Inclusion
Agreement

About you

Please tell us some details about yourself.

* denotes a required field

Title
First name *
Last name *
E-mail address *
Organisation *	Please specify: This is an NHS organisation
Organisation region *
Job title *
Telephone number *
Alternative telephone number
Work type *
Consent to storage and use of your personal data *	Please check this box to confirm that you consent to the storage and use of your personal information within the NHS South West Mentoring Hub system. The EU GDPR regulation requires us to obtain this consent from you.

Mentor details

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

* denotes a required field

I have experience in and am willing to work with someone to help them *	Career development / aspirations Develop leadership skills Support through a transition Develop emotional intelligence and manage stress
I am willing to enter into a mentoring relationship that is *	Short term (e.g. one to six sessions in order to work through a reasonably specific issue and achieve a reasonably well-defined goal) Medium term (e.g. up to six months to work through a particular transition) Long term (e.g. at different stages throughout a career)
I am willing to work within the following geographical area *	Cornwall and the Isles of Scilly Devon Somerset Bristol, North Somerset and South Gloucestershire Bath, Swindon and Wiltshire Gloucestershire Dorset
I would prefer my mentoring to take place via *	Face to face Telephone Virtual, e.g. Skype, video conferencing
Number of mentoring relationships I am willing to have at any one time *
	I am actively seeking mentees at present

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Mentee details

I would also like to register as a mentee

If you do not wish to register as a mentee, please click 'Next'.

Work type *	Accounting / Finance Administration and Clerical Allied Health Professionals Ambulance Service Team Chief Executives Chief Accountable Officers Chairs Clinical Support Staff Communications and Marketing Community Development Corporate Services Dental Doctor - General Practice (GP) Doctor - Secondary Care Doctor - Other Domestic Services Estate Services Executive Directors / CCG Governing Body Members Family Support Workers Graduate Management Training Scheme (GMTS) Health Informatics Healthcare Science Housing Improvement Information Technology (IT) Management - Finance Management - General Management - HR Management - Operational Management - Other Midwifery Non-Executive Directors and Lay Members Nursing Organisational Development (OD) Operating Department Practice Pharmacy Physician Associates / Assistants Public Health Social Workers Support Services Training and Development
I require a mentor to work with me to assist with *	Career development / aspirations Develop leadership skills Support through a transition Develop emotional intelligence and manage stress
I am willing to enter into a mentoring relationship that is *	Short term (e.g. one to six sessions in order to work through a reasonably specific issue and achieve a reasonably well-defined goal) Medium term (e.g. up to six months to work through a particular transition) Long term (e.g. at different stages throughout a career)
I would prefer my mentor to be based within the following geographical area *	Cornwall and the Isles of Scilly Devon Somerset Bristol, North Somerset and South Gloucestershire Bath, Swindon and Wiltshire Gloucestershire Dorset
I would prefer my mentoring to take place via *	Face to face Telephone Virtual, e.g. Skype, video conferencing

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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

Gender identity. Which of the following options best describes how you think of yourself? *	Woman (including trans woman) Man (including trans man) Non-binary In another way I do not wish to disclose
Is your gender identity the same as the gender you were given at birth? *	Yes No I do not wish to disclose
Your age group *	Under 20 20-29 30-39 40-49 50-59 60+ I do not wish to disclose
How would you describe your ethnic origin? *	British white Irish white White Gypsy Other white White and Black Caribbean mixed White and Black African mixed White and Asian mixed Other mixed Indian Pakistani Bangladeshi Other Asian or Asian British Caribbean African Other Black or Black British Chinese Other ethnic group I do not wish to disclose
Your religion or belief *	Atheism Buddhism Christianity Hinduism Islam Jainism Judaism Sikhism Other No religion I do not wish to disclose
Which of the following options best describes how you think of yourself? *	Heterosexual or Straight Gay or Lesbian Bisexual Other sexual orientation not listed I do not wish to disclose
Do you consider yourself to be a disabled person as defined by the Equality Act 2010? *	Yes No I do not wish to disclose
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)	Dyslexia / learning disability Blind / partially sighted Deaf / hearing impairment Mobility difficulties Personal care Mental health difficulty Unseen disability (e.g. diabetes, epilepsy, asthma) Multiple disabilities Autistic spectrum disorder (incl Asperger's Syndrome)
Other disability - please specify

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Coaching and Mentoring agreement

Please check this box to confirm that you have read and accept the below terms and conditions of use: *

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NHS South West

Mentoring

Register as a mentor

About you

Mentor details

Mentee details

Matching preferences

Diversity & Inclusion

Coaching and Mentoring agreement