IIBN UK FLP - Mentor Application Form

Personal Details

First Name


Last Name


Home Address




City


County


Postcode


Phone


Email Address


LinkedIn profile URL


What communication method(s) work best for you?


Are you an existing IIBN Member?


If yes, for how many years?


Please outline below any other Irish related business/ alumni/ network that you are a member of?




EMPLOYMENT

Name of Employer / Company (if any)


Industry


Position


Length of employment/ownership


Directorship


Nature of Business / Area of Interest


What are your areas of expertise?


EDUCATION

Education (Qualifications and years of attendance)


MENTOR-FUTURE LEADER RELATIONSHIP

Have you ever been a part of a mentorship program or acted as a mentor? If so, please briefly describe it and tell us about your experience (positive and/or negative)


What can you offer a Future Leader?


What characteristics would you like to have in a Future Leader? (i.e. budding entrepreneur, corporate focused, career changer, etc)


Does it matter to you if your Future Leader shares the same practice area as you or not?


The mentoring relationship is intended to be one of coaching, learning, connectivity and professional development. Indicate any special needs or expectations you may have.


Please provide any additional comments or information that may help in the matching process.


STATEMENT OF RELEASE & ACCURACY

* Statement of Release: I hereby give permission to release the information included on the IIBN Future Leaders Programme Mentor Application Form to the IIBN Future Leaders Programme Selection Committee for the mentor selection process. All information will be kept private and used only for the purpose of selecting mentors.

Any profiling of Mentors or Future Leaders will only be compiled with agreement by parties concerned.

I Agree

* Statement of Accuracy: I hereby certify that all information provided is true and accurate to the best of my knowledge.

I Agree

* Indicates Response Required