Look UK Mentoring Application

Please ensure you've read and understood the information supplied about the LOOK Mentoring project before submitting your application.

In order to complete your application, you will need to submit information for your DBS (Disclosure and Barring Service) check. If you do not have a valid DBS check, we will pay and process a DBS check for you, but we require supporting evidence from you in order to do this.

This application is open to visually impaired adults aged 18 - 35 to apply to train as a volunteer mentor for LOOK UK. Data gathered in this form will be stored securely according to our Data Protection Policy and will not be shared with third parties.

You can save the application form and come back to it later.

We encourage you to complete the application independently; please contact us if you have any accessibility issues on info@look-uk.org.

Your Details

The majority of the questions in this section are mandatory and will help us in preparing for your participation in a mentor training course. Please give as much detail as you're comfortable with and call us to discuss anything further.

Contact details

First Name	Surname
Email	Phone
House number/Street Name	Town/City
County	Postcode

Personal Details

Date of Birth

Ethnicity

Gender

What is your preferred pronoun?

Religion

Languages spoken

Visual Impairment & Health Conditions

Name of your eye condition(s)

Are you registered as

Please select which option primarily applies to you

Do you have any additional disabilities or health conditions other than your visual impairment?

If yes, please describe how your health conditions/ disabilities affect you and any adjustments we could make to support you.

Do you have any allergies?

Please tell us more about your allergies and describe any support you may require

Please tell us about any medication you are currently taking and describe any support you may require with this

Dietary Requirements

Dietary Needs

Dietary Needs - Other

Emergency contact details

Emergency contact full name	Emergency contact phone number
Emergency contact email	Emergency contact relationship to you

Tell us more

The information will help us support you in your mentoring training and volunteering with LOOK UK.

Please tell us what format you prefer e.g. electronic, braille grade 2, large print 18pt

How would you describe your eyesight? (e.g. light perception, can recognise colours, night blindness)

Please tell us how you usually access online materials e.g. what device, internet browser and any access software you use

Education/ Employment/ Interests

Current occupation

If other, please explain

Employment/ volunteering history: please tell us about any employment/ work experience you've had

What type of School did you attend? (e.g. mainstream, specialist)

Tell us about your Post 16 Education (if applicable). Including course(s) studied, location, and completion/graduation dates (max 100 words)

Please tell us about yourself e.g. hobbies, ambitions, interests etc.

Training & Time Commitments

LOOK UK will provide training and support for mentoring, but is there anything in particular you feel that you would need support with?

We will be running the mentor training as a residential weekend from Saturday 13th to Sunday 14th January 2024 in Birmingham.

Please confirm you can commit to attend this training session.

I agree to attend the training session

Please select the mentor programme you wish to be involved in:

Will you be able to commit to messaging your mentee at least once a week?

If you forsee any potential issues with being able to message your mentee once a week, please give us more detail here.

All LOOK Mentors are required to have a DBS certificate. Should your application be successful, we will require info of your existing DBS if you already have one, alternatively we will need supporting documents from you in order to process your DBS.

DBS requirements

Do you have an existing DBS certificate?

Please provide the following details:

Certificate number

Date of issue

If possible, please attach a copy of your DBS certificate.

If you do not have a DBS certificate

LOOK will process and pay for your DBS check; in order to do this we need you to provide the following evidence:

1 x proof of identity (passport/ birth certificate)
1 x proof of current address: this needs to be a document within the last 3 months (utility bill, bank statement, mortgage statement, PIP)
1 x supporting document (this can be any of the above or P45, P60)

Any documents that you upload here will need to be uploaded to the DDC system that LOOK use to process DBS checks. We will be in touch with more details after you have submitted the above documents. Please let us know if you need support with this on info@look-org.uk.

Please upload your proof of identity document here

Please upload your proof of current address document here.

Please upload your supporting document here.

Personal statement

Please answer the following questions which will form your personal statement. The answers given in this section will help us assess your suitability for mentoring

Please outline why you would like to become a mentor (300 words max)

Tell us about a time when you dealt with a difficult situation. What was challenging about your circumstances and how did you overcome this? (300 words max)

Tell us about a time when you demonstrated effective listening skills. (300 words max)

Tell us what sort of support you would have found useful during your school years. Do you think you would have benefited from having a mentor? If so, how? (300 words max)

Mentor Profile

Please write a mentor profile that could be used to share with your mentee should your application be successful. This profile should be no more than 300 words and should be a friendly introduction to yourself including details such as the following: Name, education history, career path or ambitions, interests and hobbies, anything you think is interesting or relevant about your family situation, any personal experience you think could be useful to a potential mentee, any particular barriers or challenges you have experience of or advice about, any topics or issues about which you are passionate.

Mentor profile (300 words max)

Reference Information

Please give details of two people who can provide a reference should your application be successful. Your references should not be from a family member or friend, and ideally should be someone who knows you professionally (this includes voluntary roles).

First Reference

First Reference - Name

First Reference - Job Title

First Reference - Relationship to You

First Reference - Phone Number

First Reference - Email

Second Reference

Second Reference - Name

Second Reference - Job Title

Second Reference - Relationship to You

Second Reference - Phone Number

Second Reference - Email

LOOK UK

LOOK UK are always interested in enhancing our service. Would you be interested in signing up for an older mentor if this was available?

Where did you find out about LOOK UK?

Please specify

Consent

Would you like to receive our newsletter to keep up to date with LOOK news and events?

Do you give your permission to be included in any media e.g. photos, video footage and audio recordings taken by LOOK UK for the purposes of future marketing, publicity and fundraising?

You may withdraw your consent at any time by contacting LOOK UK by email: info@look-uk.org. It is important to note any consent withdrawn will only relate to the future use of any media.

I confirm that this form has been completed accurately and I undertake to update LOOK UK should any information contained in this form or personal circumstances change. Contact information will be retained and used for marketing of other relevant services but will not be shared with third parties. I give consent for LOOK UK to carry out the following in accordance with the Data Protection Act 2018, and to store my personal information on LOOK's database and/ or any other suitable system. I agree to provide any relevant additional information as required.

Yes

To discuss this in more detail, please email info@look-uk.org.