SCTS WiCTS 'Lift As You Climb' Mentorship Programme - MENTEE Application
Please use this form if you would like to apply to join the WiCTS mentoring scheme as a mentee. 

The information you provide within this form will be used to best match mentor and mentees. Any information you provide here will be provided to your mentor following pairing. 

Profiles of available mentors can be found on the SCTS website at: www... 

Please review these profiles prior to completing this form to support your mentor preference choices. Please note that we will do our best to accommodate preferences but we cannot guarantee your preferred mentor(s) will be available if already paired with other mentees. 

We have asked all mentors to disclose any potential conflicts of interest. If it is felt that the mentorship you are seeking could compromise these conflicts, we may decline to pair you with your chosen mentor. For example, if you are seeking assistance to prepare for a membership exam and the mentor has declared a role within the examinations committee, this pairing would likely be declined. 

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Preferred First Name(s) *
Preferred Last Name *
Current Role(s) *
What is your current job role. Where applicable, please include details of grade of training, out-of-programme etc. 

For example, "Senior Clinical Fellow in Thoracic Surgery" or "ST5 NTN"
Current Hospital(s)/Place(s) of Work  *
Please provide your current hospital, city/town and region of work.

For example "Glenfield Hospital, Leicester, East Midlands"
Area(s) of sub-specialisation *
Please select the areas within which you work and have a future career interest. Please select any and all which apply.
Required
Key areas of expertise within which you are seeking mentorship. *
We will use your selection here to best place you with a good match mentor. Please select all areas within which you think you would like to seek mentorship. 

Please select as many as you wish.

If there is a specific area not listed here, please include this in the free-text box in the following question. Thank you.  
Required
Any other things you are seeking through a mentorship partnership that are not listed above?

Or any other comments?
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