OD Virtual Mentoring- mentor application form

Thanks for your interest! We're delighted that you're interested in training to be a Do OD Virtual Mentor. Please ensure you have read the FAQs attached to the email we sent before answering the questions.

The deadline for applications is Wednesday 31st August at 5pm. We'll be in touch soon after that! If you have any questions in the meantime, please contact do.od@nhsemployers.org

Name *

First Name Last Name

Email *

example@example.com

Phone Number *

Area Code Phone Number

Organisation *

Job role *

Please select the region you work in *

North West North East and Yorkshire Midlands East of England London South West South East National

Please describe your OD experience *

Why would you like to be an OD Virtual Mentor? *

Please describe your coaching and mentoring experience *

What qualities do you bring that others would find helpful? *

To be trained as an OD Virtual Mentor you will need to take part in a virtual briefing session on Monday 10th October from 1pm-2:30pm. Please confirm that you are able to make it. *

Yes No

The OD Virtual Mentor training takes place over three days, for four hours each. It's vital that you're able to attend all three sessions. They are booked for October 18th, 19th and 20th (Tues/Weds/Thurs) from 13:00-17:00 (with breaks) These sessions are virtual and details will be given on how to log onto the platform. Please confirm that you can attend all three sessions: *

Yes No

I agree to mentor two OD practitioners once I am trained. This will involve three sessions with each mentee over the course of four months. *

Yes

Attached to the email we sent, you'll find a set of Frequently Asked Questions. If you have a question that isn't covered please ask it here and we'll contact you directly.

The following questions are included so that we can monitor the programme for diversity and inclusion. You do not need to answer them if you do not wish to. The answers to these questions will be kept confidential (see our privacy policy below)

What is your age?

18-20 21-29 31-39 41-49 50-59 60 or older Rather not say

What is your gender?

Female (including trans female) Male (including trans male) Non binary Rather not say Other

What race/ethnicity best describes you?

White/White British Black/Black British Asian/Asian British Mixed race Rather not say Other

Do you consider yourself to have a disability?

Yes No Rather not say

What is your sexual orientation?

Lesbian or gay Bi (bisexual) Heterosexual or straight Undecided Rather not say Other

All information provided through this survey will be held by the NHS Confederation. Any personal data provided will be processed for OD Virtual Mentoring recruitment. The information collected will be processed via Jotform, on behalf of the NHS Confederation and will be shared with our partners NHS England and our trainers Black Gazelle Consulting for the purposes of recruiting mentors but will not be shared with any other third parties.

Please see our privacy policy https://www.nhsconfed.org/about-us/governance-and-accountability/nhs-confederation-privacy-notice for further information on how we will handle your data and you may opt out from communications from us at any time..