Application Form for Widening Participation Mentors

Please complete the following form to register your interest in becoming a Widening Participation Mentor.

For more information, or if you have any questions, please contact Melissa Mead on 01865 280198 or via email.

denotes a required field

First name:

Surname:

College:

Course:

Current year of study:

Preferred email address:

College address:

Permanent/home address (Including postcode):

Mobile phone number:

National Insurance Number:

Are you legally permitted to work in the UK?

Yes No

Have you ever been convicted of a criminal offence other than a minor traffic violation?

Yes No

If yes, please explain fully:

Please briefly detail, with specific examples of your relevant experience, and your motivation for applying to be a Widening Participation Mentor. Please also note any specific event you would like to work on:

Data Protection: The information that has been provided in this form is confidential and will be treated in accordance with the Data Protection Act (1998). Only organisations that require the information for the funding, delivery, evaluation and tracking of the Oxford Young Ambassadors Programme, the student’s school / college, and the Higher Education Statistics Authority will be given access to the data. We will NOT use the data provided in this form for marketing purposes. Please note: Due to both the Data Protection Act (1998) and child protection policies, only the parent / carer who has signed the form can be given access to the data provided. By selecting 'yes', you agree to us using your information in this manner.

Yes No