HDN Board Mentoring Programme 2016 - Online Mentor Application Form

PART 1: ABOUT YOU

This information will assist with matching of mentees and mentors and planning where to hold group sessions.

Name*

First Last

Email*

Telephone*

Mobile

Current Board Membership (if applicable)

Please include your organisation's name, address and your role

Current Employment (if applicable)

Please include your organisation's name, address and your role

Town or city where you live

(This may help with matching with a mentee)

How long have you been a Board Member in your current organisation?

Other/Previous Board Member experience (if applicable)

PART 2: SKILLS AND EXPERIENCES

Include a CV if you prefer

Max. file size: 200 MB.

Please tell us why you are interested in mentoring on this programme:*

Please tell us what your areas of experience/expertise that would be helpful to a mentee.

For example: Housing Sector (e.g. general knowledge, national policy etc.) Governance experience from other roles (e.g. regulatory requirements, identifying and monitoring risk, financial understanding, treasury management, value for money, social value etc.) Experience in business development (e.g. understanding property development/acquisition, strategic asset management, etc.) Experience in customer and community engagement (e.g. understanding Equalities issues, customer engagement, community development, etc.) Personal Skills (e.g. asking questions, assertiveness, identifying key issues, influencing team working, chairing meetings, etc.) Experience in mentoring, coaching or developing others

Would you be willing to contribute to any of the group development days? Content will be applied to current challenges, scenarios and case studies for Board members, it is not 'training'. Please indicate below and we will contact you with more information.

PART 3: ORGANISATION SUPPORT/ REFERENCE

Please give the name and contact details below of your Board Chair or Senior Executive who would be willing to provide a reference to support your application as a mentor on this programme. Referees will be followed up in confidence by HDN to quality assure mentors on this programme and to provide any other information which may be useful for mentee/ mentor matching.

Name*

First Last

Role*

Telephone number*

Email*

PART 4: SPECIAL REQUIREMENTS

Please specify any special requirements for accessing buildings (e.g. wheelchair or lift access), any special dietary requirements and any special requirements you have relating to communications (e.g. large print, Braille or sign language).

Note: We will try our best to accommodate all requests. In the event that we are unable to meet all requirements we will inform applicants before they are registered on the scheme.

By submitting this application you agree that the information provided in this form will be stored and used by Housing Diversity Network in accordance with our Data Protection Policy and the requirements of the Data Protection Act 1998. Information will be used by HDN staff and Associates for the purposes of managing and delivering the Board Mentoring programme. Parts 1 & 2 of this form will be passed to your mentor/mentee for their information. Your contact details may also be used by HDN for informing you of other services provided by HDN. Please tick the box below if you would prefer not to be contacted by HDN about these other services.

Please do not contact me about other services and activities provided by HDN.

DECLARATION: I am willing to be a Mentor and am able to attend four mentoring 1 to 1 meetings and appropriate group development days as part of the programme.

Yes

PART 5: EQUAL OPPORTUNITIES MONITORING FORM

What best describes your gender?

Prefer to self-describe:

How would you describe your ethnicity?

Prefer not to say

Asian, Asian British, Asian English, Asian Scottish, or Asian Welsh

Bangladeshi
Indian
Pakistani
Chinese
Any other Asian background

If from any other background please describe:

Black, Black British, Black English, Black Scottish, or Black Welsh

African
Caribbean
Any other Black background

If from any other background please describe:

Mixed/Multiple ethnic groups:

White and Asian
White and Black African
White and Black Caribbean
White and Chinese
Any other Mixed/Multiple ethnic background

If from any other background please describe:

White:

Welsh/English/Scottish/Northern Irish/British
Irish
Gypsy or Irish Traveller
Any other White background

If from any other background please describe:

Other ethnic group:

Arab
Any other ethnic group

If from any other ethnic group please describe:

Is your age between:

How would you describe you sexual orientation?

Prefer to self-describe:

How would you describe your religion/faith?

My religion/faith is: (please write in)

I am not religious
Prefer not to say

Do you concider yourself to have a disability?

If answered 'yes' to the above question please give brief details and tell us whether you may require any adjustments to enable you to attend and participate in the HDN Board Mentoring Programme.

DECLARATION - For the purposes of compliance with the Data Protection Act 1998, I hereby confirm that by completing this form I give my consent to Housing Diversity Network processing the data supplied above in connection with monitoring compliance with its equal opportunities obligations and policy. I also agree to the storage of this information on manual and computerised files.

Yes

BOARD MENTOR APPLICATION

PART 1: ABOUT YOU

PART 2: SKILLS AND EXPERIENCES

PART 3: ORGANISATION SUPPORT/ REFERENCE

PART 4: SPECIAL REQUIREMENTS

PART 5: EQUAL OPPORTUNITIES MONITORING FORM

What best describes your gender?

How would you describe your ethnicity?

Is your age between:

How would you describe you sexual orientation?

How would you describe your religion/faith?

Do you concider yourself to have a disability?

Thank you for completing!

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