*1.First and Last Name(Required.)

*2.Email Address(Required.)

*3.Which Hearing Device Do You Use?(Required.)

Cochlear Implant (using audio processor SONNET or RONDO)

BONEBRIDGE Hearing Implant (using SAMBA audio processor)

VIBRANT SOUNDBRIDGE Hearing Implant (using SAMBA audio processor)

Bone Conduction System (using ADHEAR)

*4.How long have you been using your MED-EL device?(Required.)

Less than a year

1-3 Years

3-5 Years

More than 5 Years

*5.Are you familiar with the Hearpeers community?(Required.)

Yes

No

6.In a few words tell us why you are interested in becoming a Hearpeers Volunteer Mentor?

7.I consent to MED-EL processing the information I provide, including details about my hearing device, in order to assess my suitability as a Hearpeers Volunteer Mentor. I understand that expressing interest does not guarantee acceptance into the programme.

Yes

8.I consent to MED-EL contacting me by email about the Hearpeers Mentor programme.

Yes

PRIVACY POLICY
MED-EL (UK) Ltd is the data controller for the information you provide on this form. We collect your name, email address, hearing device information, and your responses about your interest in becoming a Hearpeers Mentor to assess your suitability for the volunteer mentor programme.

Because this includes information about your hearing device, this may reveal information about your health, which is considered special category data under data protection law. We only process this with your explicit consent. (Legal basis: Consent – Art. 6(1)(a) and Art. 9(2)(a) UK GDPR).

Retention: If your application is unsuccessful, we will delete your information within 12 months. If you're accepted as a mentor, your data will be handled in line with the Hearpeers Mentor section of our main privacy policy. Which can be found here: Privacy Policy

Responses to this form are collected via a third-party survey platform used by MED-EL. Details of our data processors are available in our full privacy policy

Your rights: You have the right to access, correct, or delete your data, and to withdraw your consent at any time. You also have the right to lodge a complaint with the Information Commissioner's Office. To exercise these rights, contact our Data Protection Officer: privacy.uk@medel.com.