We Speak Mentor registration form - Spring 2024 Question Title * 1. First name Question Title * 2. Last name Question Title * 3. Email Question Title * 4. Company Question Title * 5. Job title Question Title * 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 Thur 8 Feb 2-4.30pm Thur 8 Feb 2-4.30pm Yes Thur 8 Feb 2-4.30pm No Thur 8 Feb 2-4.30pm If needs be Fri 9 Feb 2-4.30pm Fri 9 Feb 2-4.30pm Yes Fri 9 Feb 2-4.30pm No Fri 9 Feb 2-4.30pm If needs be Mon 12 Feb 2-4.30pm Mon 12 Feb 2-4.30pm Yes Mon 12 Feb 2-4.30pm No Mon 12 Feb 2-4.30pm If needs be Tues 13 Feb 2-4.30pm Tues 13 Feb 2-4.30pm Yes Tues 13 Feb 2-4.30pm No Tues 13 Feb 2-4.30pm If needs be Wed 14 Feb 2-4.30pm Wed 14 Feb 2-4.30pm Yes Wed 14 Feb 2-4.30pm No Wed 14 Feb 2-4.30pm If needs be Thurs 15 Feb 2-4.30pm Thurs 15 Feb 2-4.30pm Yes Thurs 15 Feb 2-4.30pm No Thurs 15 Feb 2-4.30pm If needs be Fri 16 Feb 2-4.30pm Fri 16 Feb 2-4.30pm Yes Fri 16 Feb 2-4.30pm No Fri 16 Feb 2-4.30pm If needs be Mon 19 Feb 2-4.30pm Mon 19 Feb 2-4.30pm Yes Mon 19 Feb 2-4.30pm No Mon 19 Feb 2-4.30pm If needs be Tues 20 Feb 2-4.30pm Tues 20 Feb 2-4.30pm Yes Tues 20 Feb 2-4.30pm No Tues 20 Feb 2-4.30pm If needs be Wed 21 Feb 2-4.30pm Wed 21 Feb 2-4.30pm Yes Wed 21 Feb 2-4.30pm No Wed 21 Feb 2-4.30pm If needs be Thurs 22 Feb 2-4.30pm Thurs 22 Feb 2-4.30pm Yes Thurs 22 Feb 2-4.30pm No Thurs 22 Feb 2-4.30pm If needs be Fri 23 Feb 2-4.30pm Fri 23 Feb 2-4.30pm Yes Fri 23 Feb 2-4.30pm No Fri 23 Feb 2-4.30pm If needs be Mon 26 Feb 1-3.30pm Mon 26 Feb 1-3.30pm Yes Mon 26 Feb 1-3.30pm No Mon 26 Feb 1-3.30pm If needs be Tues 27 Feb 10.30-1pm Tues 27 Feb 10.30-1pm Yes Tues 27 Feb 10.30-1pm No Tues 27 Feb 10.30-1pm If needs be Wed 28 Feb 10.30-1pm Wed 28 Feb 10.30-1pm Yes Wed 28 Feb 10.30-1pm No Wed 28 Feb 10.30-1pm If needs be Thurs 29 Feb 10.30-1pm Thurs 29 Feb 10.30-1pm Yes Thurs 29 Feb 10.30-1pm No Thurs 29 Feb 10.30-1pm If needs be Question Title * 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 5-6pm on Mondays (26 Feb, 4, 11 & 18 Mar) 5-6pm on Mondays (26 Feb, 4, 11 & 18 Mar) Yes 5-6pm on Mondays (26 Feb, 4, 11 & 18 Mar) No 5-6pm on Mondays (26 Feb, 4, 11 & 18 Mar) If needs be 3.30-4.30pm on Tuesdays (27 Feb, 5, 12 & 19 Mar) 3.30-4.30pm on Tuesdays (27 Feb, 5, 12 & 19 Mar) Yes 3.30-4.30pm on Tuesdays (27 Feb, 5, 12 & 19 Mar) No 3.30-4.30pm on Tuesdays (27 Feb, 5, 12 & 19 Mar) If needs be 3.30-4.30pm on Wednesdays (28 Feb, 6, 13 & 20 Mar) 3.30-4.30pm on Wednesdays (28 Feb, 6, 13 & 20 Mar) Yes 3.30-4.30pm on Wednesdays (28 Feb, 6, 13 & 20 Mar) No 3.30-4.30pm on Wednesdays (28 Feb, 6, 13 & 20 Mar) If needs be 3.30-4.30pm on Thursdays (29 Feb, 7, 14 & 21 Mar) 3.30-4.30pm on Thursdays (29 Feb, 7, 14 & 21 Mar) Yes 3.30-4.30pm on Thursdays (29 Feb, 7, 14 & 21 Mar) No 3.30-4.30pm on Thursdays (29 Feb, 7, 14 & 21 Mar) If needs be 3.30-4.30pm on Fridays (1, 8, 15 & 22 Mar) 3.30-4.30pm on Fridays (1, 8, 15 & 22 Mar) Yes 3.30-4.30pm on Fridays (1, 8, 15 & 22 Mar) No 3.30-4.30pm on Fridays (1, 8, 15 & 22 Mar) If needs be Other (please specify) Question Title * 8. Please state any dates that you'd need to miss Question Title * 9. 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 Question Title * 10. Why would you like to take part in the programme? Question Title * 11. 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 Question Title * 12. 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 No Question Title * 13. 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. Done