We Speak Mentor registration form - Autumn 2022

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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 (Please say Yes to as many options as possible as we'll choose the most popular ones)

	Yes	No
Wed 12 Oct 2-4.30pm	Wed 12 Oct 2-4.30pm Yes	Wed 12 Oct 2-4.30pm No
Thur 13 Oct 2-4.30pm	Thur 13 Oct 2-4.30pm Yes	Thur 13 Oct 2-4.30pm No
Fri 14 Oct 2-4.30pm	Fri 14 Oct 2-4.30pm Yes	Fri 14 Oct 2-4.30pm No
Mon 17 Oct 2-4.30pm	Mon 17 Oct 2-4.30pm Yes	Mon 17 Oct 2-4.30pm No
Tues 18 Oct 2-4.30pm	Tues 18 Oct 2-4.30pm Yes	Tues 18 Oct 2-4.30pm No
Wed 19 Oct 2-4.30pm	Wed 19 Oct 2-4.30pm Yes	Wed 19 Oct 2-4.30pm No
Mon 24 Oct 2-4.30pm	Mon 24 Oct 2-4.30pm Yes	Mon 24 Oct 2-4.30pm No
Tues 25 Oct 2-4.30pm	Tues 25 Oct 2-4.30pm Yes	Tues 25 Oct 2-4.30pm No
Wed 26 Oct 2-4.30pm	Wed 26 Oct 2-4.30pm Yes	Wed 26 Oct 2-4.30pm No
Thur 27 Oct 2-4.30pm	Thur 27 Oct 2-4.30pm Yes	Thur 27 Oct 2-4.30pm No
Fri Oct 28 2-4.30pm	Fri Oct 28 2-4.30pm Yes	Fri Oct 28 2-4.30pm No

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* 7. Programme - which dates are you available for? Please say Yes as many options as possible (including ones where you can only make 3/4 of the dates) so we can find the best dates for everyone.

	Yes	No
3.30-4.30pm on Mondays (7, 14, 21, 28 Nov)	3.30-4.30pm on Mondays (7, 14, 21, 28 Nov) Yes	3.30-4.30pm on Mondays (7, 14, 21, 28 Nov) No
3.30-4.30pm on Tuesdays (8, 15, 22, 29 Nov)	3.30-4.30pm on Tuesdays (8, 15, 22, 29 Nov) Yes	3.30-4.30pm on Tuesdays (8, 15, 22, 29 Nov) No
3.30-4.30pm on Wednesdays (9, 16, 23, 30 Nov)	3.30-4.30pm on Wednesdays (9, 16, 23, 30 Nov) Yes	3.30-4.30pm on Wednesdays (9, 16, 23, 30 Nov) No
3.30-4.30pm on Thursdays (10, 17, 24 Nov & 1 Dec)	3.30-4.30pm on Thursdays (10, 17, 24 Nov & 1 Dec) Yes	3.30-4.30pm on Thursdays (10, 17, 24 Nov & 1 Dec) No
3.30-4.30pm on Fridays (11, 18, 25 Nov & 2 Dec)	3.30-4.30pm on Fridays (11, 18, 25 Nov & 2 Dec) Yes	3.30-4.30pm on Fridays (11, 18, 25 Nov & 2 Dec) No

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

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* 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

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

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* 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

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* 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

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* 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

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 Employment programme, that we can record sessions for safeguarding and evaluation purposes, that we can take quotations from feedback and sessions to be published anonymously (ie without your name) 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.