Register – The Black Excellence Network

- Full Name*
- E-mail* If you are in university please provide your university email
- What city are you currently living in?
- Mobile Number* Required phone number format: ###########
- Password* Minimum length of 8 characters.
  The password must have a minimum strength of StrongStrength indicator
- Repeat Password*
- Role*
  - Mentor
  - Mentee
  - Member
  - Mentor(from 2020 cohort)
- Parent/Guardian Full Name*
- Parent/Guardian Email Address*
- Ethnicity*
  - Black African
  - Black Caribbean
  - Black Caribbean and African
  - Black African and other ethnicity
  - Black Caribbean and other ethnicity
- What year group are you currently in? (as of July 2021)*
  - Year 11
  - Year 12
  - Year 13
- Education Level*
  - Undergraduate
  - Graduate
- Education Level (Member)*
  - Year 12
  - Year 13
  - Undergraduate
  - Postgraduate
  - Full time Employment
  - Other
- Which university are you attending/ did you attend?*
- What is/was the title of your course?*
- What A-Level/IB subjects did you take?* Biology, Chemistry, Mathematics
- List the universities and courses you applied to during your UCAS application* University of Manchester - PPE University of Nottingham - Politics University of Oxford - PPE etc.
- Which one of these newsletters would you like to subscribe to?
  - Medicine Newsletter
  - STEM Newsletter
  - Humanities Newsletter
  - Law Newsletter
  - Economics Newsletter
  - Apprenticeships Newsletter
  - Maths and Finance Newsletter
  You will automatically be subscribed to our General Newsletter.
- What is the name of the school you attended during GCSEs?*
- What A-Levels/IB subjects do you take? What are your target/predicted grades? (Leave blank if unknown) Your answer English A*, Maths A, Further Maths A, etcList your A Level subjects and expected grades, separated by commas
- What are your achieved GCSE grades?* English A*, Maths A, Physics A, etcList each GCSE module and grade separated by a comma.
- What type of school do you attend? *
  - Fee paying
  - Non-fee paying
- What course(s) are you considering to study at university? (You may put the subject area if unsure e.g Humanities) *
- What universities are you considering applying to?* Durham, Bristol, BrunelInput your list of universities, separated by commas
- Have you been eligible for free school meals in the last 5 years? *
  - Yes
  - No
  - Unsure
  - Rather not say
- Define Black Excellence in 1-2 sentences.*
- What do you think you can offer to your mentee to help them excel?*
- How did you hear about us?
- What are your long term goals? *
- What do you want to gain from joining the Black Excellence Network? *
- I confirm that I was part of the 'Unallocated Mentors 2020-2021'
- I, the mentee confirm that I have read and agree to the terms outlined below. *https://www.blackexcellencenetwork.net/privacy-policy/ https://www.blackexcellencenetwork.net/safeguarding-policy/
- I, the mentor/member confirm that I have read and agree to the terms outlined below. *https://www.blackexcellencenetwork.net/privacy-policy/ https://www.blackexcellencenetwork.net/safeguarding-policy/
- I, the parent/guardian of the mentee confirm that I have read and agree to the terms outlined above.*

Send these credentials via email.