We Speak Mentor registration form - Summer 2024

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* 1. First name

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* 2. Last name

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* 3. Email

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* 4. Company

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* 5. Job title

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* 6. Mentor training - which dates are you available for? All sessions take place 2-4.30pm (You'll only attend 1 session but please say Yes to as many options as possible as we'll choose the most popular dates)

	Yes	No	If needs be
Wed 29 May 2-4.30pm	Wed 29 May 2-4.30pm Yes	Wed 29 May 2-4.30pm No	Wed 29 May 2-4.30pm If needs be
Thurs 30 May 2-4.30pm	Thurs 30 May 2-4.30pm Yes	Thurs 30 May 2-4.30pm No	Thurs 30 May 2-4.30pm If needs be
Fri 31 May 2-4.30pm	Fri 31 May 2-4.30pm Yes	Fri 31 May 2-4.30pm No	Fri 31 May 2-4.30pm If needs be
Mon 3 June 2-4.30pm	Mon 3 June 2-4.30pm Yes	Mon 3 June 2-4.30pm No	Mon 3 June 2-4.30pm If needs be
Tue 4 June 2-4.30pm	Tue 4 June 2-4.30pm Yes	Tue 4 June 2-4.30pm No	Tue 4 June 2-4.30pm If needs be
Wed 5 June 2-4.30pm	Wed 5 June 2-4.30pm Yes	Wed 5 June 2-4.30pm No	Wed 5 June 2-4.30pm If needs be
Thurs 6 June 2-4.30pm	Thurs 6 June 2-4.30pm Yes	Thurs 6 June 2-4.30pm No	Thurs 6 June 2-4.30pm If needs be
Fri 7 June 2-4.30pm	Fri 7 June 2-4.30pm Yes	Fri 7 June 2-4.30pm No	Fri 7 June 2-4.30pm If needs be
Mon 10 June 2-4.30pm	Mon 10 June 2-4.30pm Yes	Mon 10 June 2-4.30pm No	Mon 10 June 2-4.30pm If needs be

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* 7. Programme - which dates are you available for? (You'll attend 1 hour a week over 4 weeks, on the same day/time each week. Please say Yes as many options as possible so we can find the best dates for everyone.)

	Yes	No	If needs be
3.30-4.30pm on Tuesdays (11, 18, 25 June, 2 July)	3.30-4.30pm on Tuesdays (11, 18, 25 June, 2 July) Yes	3.30-4.30pm on Tuesdays (11, 18, 25 June, 2 July) No	3.30-4.30pm on Tuesdays (11, 18, 25 June, 2 July) If needs be
3.30-4.30pm on Wednesdays (12, 19, 26 June, 3 July)	3.30-4.30pm on Wednesdays (12, 19, 26 June, 3 July) Yes	3.30-4.30pm on Wednesdays (12, 19, 26 June, 3 July) No	3.30-4.30pm on Wednesdays (12, 19, 26 June, 3 July) If needs be
3.30-4.30pm on Thursdays (13, 20, 27 June, 4 July)	3.30-4.30pm on Thursdays (13, 20, 27 June, 4 July) Yes	3.30-4.30pm on Thursdays (13, 20, 27 June, 4 July) No	3.30-4.30pm on Thursdays (13, 20, 27 June, 4 July) If needs be

Other (please specify)

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* 8. Please state any dates that you'd need to miss

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* 9. Would you prefer to take part as a mentor in Summer or Autumn?

Summer (June)

Autumn (November)

Either is fine

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* 10. If you had the choice, would you prefer your sessions with the students to be 1 or 1.5 hours?

1 hour

1.5 hours

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* 11. Why would you like to take part in the programme?

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* 12. Rate your skills on scale of 1-10, where 1 is 'skill not developed' and 10 is 'skill completely developed'. (The We Speak mentor training will help you develop these skills so it's useful to know your assessment of this)

	1	2	3	4	5	6	7	8	9	10
Active listening	Active listening 1	Active listening 2	Active listening 3	Active listening 4	Active listening 5	Active listening 6	Active listening 7	Active listening 8	Active listening 9	Active listening 10
Asking open questions	Asking open questions 1	Asking open questions 2	Asking open questions 3	Asking open questions 4	Asking open questions 5	Asking open questions 6	Asking open questions 7	Asking open questions 8	Asking open questions 9	Asking open questions 10
Giving supportive feedback	Giving supportive feedback 1	Giving supportive feedback 2	Giving supportive feedback 3	Giving supportive feedback 4	Giving supportive feedback 5	Giving supportive feedback 6	Giving supportive feedback 7	Giving supportive feedback 8	Giving supportive feedback 9	Giving supportive feedback 10
Helping others build their confidence	Helping others build their confidence 1	Helping others build their confidence 2	Helping others build their confidence 3	Helping others build their confidence 4	Helping others build their confidence 5	Helping others build their confidence 6	Helping others build their confidence 7	Helping others build their confidence 8	Helping others build their confidence 9	Helping others build their confidence 10

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* 13. Are you happy for We Speak to email you with updates including social impact of the work you're doing or any We Speak opportunities you may be interested in. We will process your data in accordance with our privacy policy (www.wespeak.co/privacy-policy). You can withdraw consent any time by emailing laura@wespeak.co, or clicking unsubscribe on communications

Yes

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* 14. Are you happy for us to use screenshots and videos for promotional purposes? (Tick or leave blank as appropriate)

	Yes
Yes, I am happy for you to use screenshots	Yes, I am happy for you to use screenshots Yes
Yes, I am happy for you to use videos	Yes, I am happy for you to use videos Yes
Yes, I am happy for you to use my name next to quotes	Yes, I am happy for you to use my name next to quotes Yes
Yes, I am happy for you to use my name next to screenshots	Yes, I am happy for you to use my name next to screenshots Yes
No, I'm not happy for you to use screenshots, videos or my name	No, I'm not happy for you to use screenshots, videos or my name Yes

This might include but is not limited to the right to use them in our printed and online publicity, social media and programme material. We will process your data in line with our privacy policy (www.wespeak.co/privacy-policy). You can withdraw your consent at any time by emailing laura@wespeak.co

By submitting this form you are agreeing that We Speak will contact you about the We Speak programme, that we can record sessions for safeguarding and evaluation purposes, that we can take quotations from feedback and sessions to be published anonymously to promote We Speak's work, and you agree that we will process your data in line with our privacy policy (www.wespeak.co/privacy-policy). We will keep information for a reasonable period.