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NCL Mentoring application
NCL Mentoring application
*
1.
Full Name
(Required.)
*
2.
Email address
(Required.)
*
3.
What is your profession?
(Required.)
Advanced Practitioner
First Contact Practitioner
GP
GPN
Nurse
Nursing Associate
Paramedic
Pharmacist
Physician Associate
Practice manager
Other (please specify)
*
4.
Date you qualified:
(Required.)
*
5.
Which practice are you currently employed with?
(Required.)
*
6.
Type of employment
(Required.)
Locum
Long term locum
Out of hours
Partner
Permanent
Salaried
Other (please specify)
*
7.
Which borough are you currently working in?
(Required.)
Barnet
Camden
Enfield
Haringey
Islington
Interested in moving into NCL
Other (please specify)
*
8.
Where did you hear about the NCL mentoring programme?
(Required.)
GP Webinar
Your Practice manager
NCL Training Hub Website
NCL Newsletter
LinkedIn
GP Bulletin
through my PCN Educator Lead
Previously accessed mentoring via the NCL Training Hub
Other (please specify)
9.
What do you hope to achieve or gain from participating in mentoring?
10.
If you have previously accessed mentoring via the NCL Training Hub, please provide details about the reason you'd like further sessions.
11.
If you have requested further mentoring, please indicate if this is a new issue or has been ongoing since you last accessed mentoring.
I'd like to have further mentoring to discuss a new issue
I'd like to have further mentoring to discuss an ongoing issue
12.
If you are requesting further mentoring sessions, please indicate how many you think you might need.