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 Strong
Strength indicator
Repeat Password
*
Role
*
Mentor
Mentee
Member
Mentor(from 2020 cohort)
Mentorship is currently closed but will be open once the next cycle begins. If you are still interested in mentorship please register as a mentor/mentee and you will be contacted later on.
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)
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Year 11
Year 12
Year 13
Education Level
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Undergraduate
Graduate
Education Level (Member)
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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?
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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, etc
List your A Level subjects and expected grades, separated by commas
What are your achieved GCSE grades?
*
English A*, Maths A, Physics A, etc
List 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?
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Durham, Bristol, Brunel
Input your list of universities, separated by commas
Have you been eligible for free school meals in the last 5 years?
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Yes
No
Unsure
Rather not say
Define Black Excellence in 1-2 sentences.
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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?
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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://blackexcellencenetwork.net/privacy-policy/ https://blackexcellencenetwork.net/safeguarding-policy/
I, the mentor/member confirm that I have read and agree to the terms outlined below.
*
https://blackexcellencenetwork.net/privacy-policy/ https://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.