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Expression of Interest - Step Up Mentoring Programme for Mentees

This short form is to help us understand if you might like to take part in the OMG x City of London Step Up Mentoring Programme.

It is not an application and does not commit you to anything.

If you are interested, a member of the team will contact you to talk through the programme and, if you’re happy, move on to the full referral stage.

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1. What is your full name?  *
2. What name do you prefer to be called? 
3. Age *
4. Do you identify as care-experienced?  *
5. What is the best phone number to contact you on?  *
6. What is your email address?  *
7. What is the best way to contact you?  *
 8. Which statement best reflects your current situation?   *
Required
  9. What areas of support do you feel may be helpful at this time?   *
Required
  10. Have you previously engaged in mentoring or coaching support?  
Clear selection
 11.  What would you hope to gain from mentoring support?  

  You can keep this short. There are no right or wrong answers.   *
  12. Do you currently have a worker or professional supporting you?   *
13. If yes, who is that professional? 
Clear selection
  14. Name and role of professional (if applicable)  
15. Do you consent to being contacted by OMG to discuss the Step Up Mentoring Programme?
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16. Do you consent to relevant information being shared between OMG, mentors, the City of London Corporation, and other involved professionals where necessary for safeguarding, wellbeing, or support planning?  

 Please note: this would only be shared on a need-to-know basis and in line with safeguarding and data protection requirements.  
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17.  Safeguarding override acknowledgement *
Required
17. Is there anything else you would like us to be aware of at this stage? 
18. Are you happy for this information to be used to determine next steps and, if appropriate, progress to a full referral?   *

Thank you for submitting your Expression of Interest.

A member of the OMG team will review the information provided and make contact where appropriate.

Submission of this form does not guarantee enrolment and you may choose not to proceed at any stage.

You are under no obligation to continue if you decide it’s not right for you. 
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