Personal details

First name:

Surname:

Student ID Number:

University email address:

Private email address:

Preferred email address to contact:

Term address:

Term postcode:

Home address:

Home postcode:

Mobile number:

Home number:

Student category:

Gender:

Has anyone in your immediate family completed a university degree? Immediate includes mother, father, brother or sister:

Did you come to the Faculty of Biological Sciences via the Access to Leeds scheme?:

Have you received financial assistance from the University of Leeds i.e. bursary/scholarships?:

Are you an Access to Leeds / Leeds Hardship Fund recipient?:

Are you applying for, or have you completed, the Study Abroad scheme?:

Are you applying for, or have you completed, an industrial placement year?:

Do you have a disability:

If you have a disability, please specify:

If you require any special assistance or facilities e.g. interpreter, wheelchair access, please specify:

Education

Full title of current course:

Year of entry to the Faculty of Biological Sciences: e.g. 2014

Date due to complete studies (mm/yyyy):

Qualifications

Please state your academic qualifications gained:
University end-of-year results if known e.g. Year 1 Average 67% = 2:1
A Level or equivalent grades e.g. A Level Maths – A, Biology A, Chemistry B
GCSE grades in Maths and English e.g. 8 GCSEs A – C (A in English and B in Maths)

Please provide brief details of any work experience (including your most significant part-time and temporary jobs)
Please indicate the name of the employer, the start and end date of employment and job title.

Interest/Hobbies

Career plans

Please rank up to three careers in which you are most interested (1 being the area in which you are most interested)

Career 1

Career 2

Career 3

What help do you think you might need to achieve your career goals?
Please choose the top 3 issues on which you need the most support.

Career choice and direction

Applications and CVs (entry requirements)

Qualities and skills needed to succeed in chosen career

Professional training and development

Interview skills

Time management and prioritising deadlines

Communication skills","Presentation skills

Confidence and assertiveness

Group work and teamworking skills

Dealing with and overcoming challenges

Building professional relationships and networking

Career aspirations

Your comments here will be used in the selection and matching process, so please ensure that you complete the following sections fully.

What makes you an ideal candidate for our mentoring scheme?
(for example, what qualities and skills will you bring to the scheme?)
0/150 words maximum

What do you hope to gain by being involved in our mentoring scheme? Where specifically would you like support?
0/200 words maximum

Employer matching

Would you prefer to work with a mentor from a particular background?

If yes, please state which particular background you would like your mentor to be from and why:

How would you like to be mentored? (Choose 1 or more options)

Face to face

Phone

Skype

Preferred method?

Mentee declaration

By submitting this application I am agreeing with the following statement:

If selected to participate in the Nurturing Talent Mentor Scheme:

I can confirm that the contents of my application are true and accurate
I will contribute to the mentoring initiative to the best of my ability
I will attend the required training and evaluation events
I understand that I am responsible for my own health and safety
I agree that a prospective mentor can look at my application before any match is agreed
I will keep regular contact with my mentor and inform the Leeds University Faculty of Biological Sciences if I face any problems