We Speak Mentor registration form - Belcan Autumn 2025

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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 - for Autumn, which dates are you available for? (You'll only attend 1 session but please say Yes to as many options as possible as we'll choose the most popular dates). Sessions either take place at 10am-12.30pm or 2-4.30pm.

	Yes	No	If needs be
Mon 13 Oct 2-4.30pm	Mon 13 Oct 2-4.30pm Yes	Mon 13 Oct 2-4.30pm No	Mon 13 Oct 2-4.30pm If needs be
Tue 14 Oct 10am-12.30pm	Tue 14 Oct 10am-12.30pm Yes	Tue 14 Oct 10am-12.30pm No	Tue 14 Oct 10am-12.30pm If needs be
Tue 14 Oct 2-4.30pm	Tue 14 Oct 2-4.30pm Yes	Tue 14 Oct 2-4.30pm No	Tue 14 Oct 2-4.30pm If needs be
Wed 15 Oct 2-4.30pm	Wed 15 Oct 2-4.30pm Yes	Wed 15 Oct 2-4.30pm No	Wed 15 Oct 2-4.30pm If needs be
Thurs 16 Oct 2-4.30pm	Thurs 16 Oct 2-4.30pm Yes	Thurs 16 Oct 2-4.30pm No	Thurs 16 Oct 2-4.30pm If needs be
Fri 17 Oct 2-4.30pm	Fri 17 Oct 2-4.30pm Yes	Fri 17 Oct 2-4.30pm No	Fri 17 Oct 2-4.30pm If needs be
Mon 20 Oct 2-4.30pm	Mon 20 Oct 2-4.30pm Yes	Mon 20 Oct 2-4.30pm No	Mon 20 Oct 2-4.30pm If needs be
Tue 21 Oct 10am-12.30pm	Tue 21 Oct 10am-12.30pm Yes	Tue 21 Oct 10am-12.30pm No	Tue 21 Oct 10am-12.30pm If needs be
Tue 21 Oct 2-4.30pm	Tue 21 Oct 2-4.30pm Yes	Tue 21 Oct 2-4.30pm No	Tue 21 Oct 2-4.30pm If needs be
Wed 22 Oct 2-4.30pm	Wed 22 Oct 2-4.30pm Yes	Wed 22 Oct 2-4.30pm No	Wed 22 Oct 2-4.30pm If needs be
Thurs 23 Oct 2-4.30pm	Thurs 23 Oct 2-4.30pm Yes	Thurs 23 Oct 2-4.30pm No	Thurs 23 Oct 2-4.30pm If needs be
Fri 24 Oct 2-4.30pm	Fri 24 Oct 2-4.30pm Yes	Fri 24 Oct 2-4.30pm No	Fri 24 Oct 2-4.30pm If needs be
Mon 27 Oct 2-4.30pm	Mon 27 Oct 2-4.30pm Yes	Mon 27 Oct 2-4.30pm No	Mon 27 Oct 2-4.30pm If needs be
Tue 28 Oct 10am-12.30pm	Tue 28 Oct 10am-12.30pm Yes	Tue 28 Oct 10am-12.30pm No	Tue 28 Oct 10am-12.30pm If needs be
Tue 28 Oct 2-4.30pm	Tue 28 Oct 2-4.30pm Yes	Tue 28 Oct 2-4.30pm No	Tue 28 Oct 2-4.30pm If needs be
Wed 29 Oct 2-4.30pm	Wed 29 Oct 2-4.30pm Yes	Wed 29 Oct 2-4.30pm No	Wed 29 Oct 2-4.30pm If needs be
Thur 30 Oct 2-4.30pm	Thur 30 Oct 2-4.30pm Yes	Thur 30 Oct 2-4.30pm No	Thur 30 Oct 2-4.30pm If needs be
Fri 31 Oct 2-4.30pm	Fri 31 Oct 2-4.30pm Yes	Fri 31 Oct 2-4.30pm No	Fri 31 Oct 2-4.30pm If needs be

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* 7. Autumn Programme - which dates are you available for? (You'll attend 1 hour a week over 4 weeks, on the same day/time each week. Please say Yes as many options as possible so we can find the best dates for everyone.)

	Yes	No	If needs be
3.30-4.30pm on Mondays (3, 10, 14, 24 November)	3.30-4.30pm on Mondays (3, 10, 14, 24 November) Yes	3.30-4.30pm on Mondays (3, 10, 14, 24 November) No	3.30-4.30pm on Mondays (3, 10, 14, 24 November) If needs be
5-6pm on Mondays (3, 10, 14, 24 November)	5-6pm on Mondays (3, 10, 14, 24 November) Yes	5-6pm on Mondays (3, 10, 14, 24 November) No	5-6pm on Mondays (3, 10, 14, 24 November) If needs be
3.30-4.30pm on Tuesdays (4, 11, 18, 25 November)	3.30-4.30pm on Tuesdays (4, 11, 18, 25 November) Yes	3.30-4.30pm on Tuesdays (4, 11, 18, 25 November) No	3.30-4.30pm on Tuesdays (4, 11, 18, 25 November) If needs be
5-6pm on Tuesdays (4, 11, 18, 25 November)	5-6pm on Tuesdays (4, 11, 18, 25 November) Yes	5-6pm on Tuesdays (4, 11, 18, 25 November) No	5-6pm on Tuesdays (4, 11, 18, 25 November) If needs be
3.30-4.30pm on Wednesdays (5, 12, 19, 26 November)	3.30-4.30pm on Wednesdays (5, 12, 19, 26 November) Yes	3.30-4.30pm on Wednesdays (5, 12, 19, 26 November) No	3.30-4.30pm on Wednesdays (5, 12, 19, 26 November) If needs be
3.30-4.30pm on Thursdays (6, 13, 20, 27 November)	3.30-4.30pm on Thursdays (6, 13, 20, 27 November) Yes	3.30-4.30pm on Thursdays (6, 13, 20, 27 November) No	3.30-4.30pm on Thursdays (6, 13, 20, 27 November) If needs be
3.30-4.30pm on Fridays (7, 14, 21, 28 November)	3.30-4.30pm on Fridays (7, 14, 21, 28 November) Yes	3.30-4.30pm on Fridays (7, 14, 21, 28 November) No	3.30-4.30pm on Fridays (7, 14, 21, 28 November) If needs be

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

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

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* 10. 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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* 11. 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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* 12. Are you happy for us to use screenshots and videos for promotional purposes?

	Yes	No
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 screenshots No
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 videos No
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 quotes No
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	Yes, I am happy for you to use my name next to screenshots No

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 programme, that we can record sessions for safeguarding and evaluation purposes, that we can take quotations from feedback, surveys and sessions to be published anonymously to share and promote We Speak's work, that we can share feedback from students with their mentors, and feedback from mentors with their students, during and after the programme to ensure there is a continual learning process, 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.