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Pharmacy Research UK
Improving the health of the public through excellence in pharmacy research.
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Mentor Form
Mentor Form
Mentor Submission Form
Instructions
Thank you for your interest in acting as a Mentor for the PRUK Mentoring Scheme. Before signing up as a mentor, we recommend that you read the Mentoring Handbook and understand the commitment and requirements of the Mentor role. If you have any further questions, do not hesitate to contact a member of the PRUK team.
Your Details
Name
*
(Please enter your full name)
Title
(Please select one from the list below)
Mr
Mrs
Miss
Ms
Dr
Professor
Associate Professor
Reader
Research Associate
Job Title
Institution(s)
(Please enter your employer's name and any other institutions that you are affiliated with)
Phone
(Please enter your best contact number)
Email
*
(Please enter your current work email)
Your Expertise
Research Expertise
*
(Please enter key words of your research expertise/area)
Research Experience
*
(e.g. how many grants have you received, experience as a lead/co-applicant etc.)
Mentor Experience
*
(Please give some details on any previous experience you have, if any, on being a mentor. Please also outline any mentor training you have undertaken.)
Mentor Goals
*
(Please explain what you hope to gain from signing up to become a mentor)
Your Commitment and Availability
Contact Preference
*
(For Mentee)
Email
Phone
In person
Virtual (via webcam)
Number of Mentees
*
(How many mentees would you be prepared to assist at any one time?)
1
Up to 2
Up to 3
Up to 4
Commitment
*
(Please enter how much time you can commit to this scheme - a minimum of 2 hours per month [per mentee] is recommended)
Other
Other Schemes
Please list the other mentoring schemes you are part of (if any)
How did you hear about us?
*
CV
*
Please upload your CV
Additional Attachments
You are welcome to upload any other document to support your application
Declaration
By submitting this form, I confirm that I understand the commitments required as a mentor for this scheme and that I will be contacted once a suitable mentee has been identified.
Verification
Please enter any two digits
*
Example: 12
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