Mentor Registration London Excellence Mentor Application I wish to apply to be a London Excellence Mentor. Question Title * 1. I understand that I will be asked to pay a non-refundable registration fee. The registration fee is £65+vat for Ambassadors for Excellence, £95+vat for others*.London Excellence will provide a half-day workshop to introduce the role and refresh your skills. You will be provided with a certificate of attendance at the workshop that can contribute to a portfolio of evidence should you wish to work towards a qualification in coaching and mentoring.Attendance at the workshop does not guarantee that you will be accepted as a London Excellence Mentor. Nor can we guarantee that we can match you immediately with an appropriate mentee.If you agree to act as a mentor you must be prepared to commit to the relationship. This will nomally include supporting the mentee through six 90-minute sessions over a 6-month period - although this may vary if agreed between yourself and your mentee.* Special introductory fees for the pilot programme I agree Question Title * 2. Please enter your: First Name Surname Job Role Company Email Telephone Number Question Title * 3. I have experience in the: No experience Some experience Extensive experience Public sector Public sector No experience Public sector Some experience Public sector Extensive experience Private sector Private sector No experience Private sector Some experience Private sector Extensive experience Not-for-profit sector Not-for-profit sector No experience Not-for-profit sector Some experience Not-for-profit sector Extensive experience Question Title * 4. I have experience in organisations employing: No experience Some experience Extensive experience 1 - 25 people 1 - 25 people No experience 1 - 25 people Some experience 1 - 25 people Extensive experience 26 - 50 people 26 - 50 people No experience 26 - 50 people Some experience 26 - 50 people Extensive experience 51 - 250 people 51 - 250 people No experience 51 - 250 people Some experience 51 - 250 people Extensive experience 251 - 1000 people 251 - 1000 people No experience 251 - 1000 people Some experience 251 - 1000 people Extensive experience >1000 people >1000 people No experience >1000 people Some experience >1000 people Extensive experience Question Title * 5. I have personal experience of leading / managing: No experience Some experience Extensive experience 1 - 10 people 1 - 10 people No experience 1 - 10 people Some experience 1 - 10 people Extensive experience 11 - 50 people 11 - 50 people No experience 11 - 50 people Some experience 11 - 50 people Extensive experience 51 - 250 people 51 - 250 people No experience 51 - 250 people Some experience 51 - 250 people Extensive experience 251 - 1000 people 251 - 1000 people No experience 251 - 1000 people Some experience 251 - 1000 people Extensive experience >1000 people >1000 people No experience >1000 people Some experience >1000 people Extensive experience Question Title * 6. I have personal experience of managing budgets in excess of: No experience Some experience Extensive experience £100,000 £100,000 No experience £100,000 Some experience £100,000 Extensive experience £250,000 £250,000 No experience £250,000 Some experience £250,000 Extensive experience £500,000 £500,000 No experience £500,000 Some experience £500,000 Extensive experience £1 million £1 million No experience £1 million Some experience £1 million Extensive experience £10 million £10 million No experience £10 million Some experience £10 million Extensive experience Question Title * 7. I feel confident to mentor someone who wishes to improve their organisation's: No thank you Confident Very confident Customer focus Customer focus No thank you Customer focus Confident Customer focus Very confident Innovation and creativity Innovation and creativity No thank you Innovation and creativity Confident Innovation and creativity Very confident Strategic direction / leadership Strategic direction / leadership No thank you Strategic direction / leadership Confident Strategic direction / leadership Very confident Partnerships with other organisations Partnerships with other organisations No thank you Partnerships with other organisations Confident Partnerships with other organisations Very confident Management systems Management systems No thank you Management systems Confident Management systems Very confident Management of their people Management of their people No thank you Management of their people Confident Management of their people Very confident Performance & growth Performance & growth No thank you Performance & growth Confident Performance & growth Very confident Sustainability & corporate responsibility Sustainability & corporate responsibility No thank you Sustainability & corporate responsibility Confident Sustainability & corporate responsibility Very confident Question Title * 8. I feel confident to mentor someone who wishes to explore their: No thank you Confident Very confident Career direction Career direction No thank you Career direction Confident Career direction Very confident Transition into a new role Transition into a new role No thank you Transition into a new role Confident Transition into a new role Very confident Other (please specify) Question Title * 9. Please tell us what you feel that you can bring to a mentoring relationship in terms of knowledge, skills, behaviours and networks. Question Title * 10. I can attend a half-day workshop on: 16th July 2012 (am) Please keep me on your list for future workshops Done