e-Mentor Registration Form

This form allows you to register for the Mullany Fund Life Sciences e-Mentoring Project. Fields marked with a star (*) have to be filled to complete registration.

If you save the form and the page doesn't forward to a successful submission message, check the form thoroughly for errors.

About You

Details here are the basics we need to know about you in order to register you with the project.


First Name *

Last Name *

Preferred Alias

Gender *

About Your Expertise

Details here will help us match you up with the most appropriate mentees.

Job Title / Current Course *

Speciality 1 *

Speciality 2

Speciality 3

Attend University *

Background Details

Details here will be used to set you up on the e-mentoring platform.

E-mail *

E-mail Confirm *

Phone Number *

Alternative Phone Number

DBS Check

Equalities Monitoring and Other Details

Details here are to help us with monitoring how well we succeed in helping all of the communities engaged with us.

Hear about us



Home Post Code

Careers Talks


Further Information

The project works in Swansea and Neath Port Talbot to give students a professional mentor. The mentoring sessions last a few months each, and expect a time commitment of about half an hour a week from those involved. For more details see the main website project pages.

We aim to supply every application with a mentoring relationship, but cannot guarantee it.

This project is funded by the Big Lottery Fund.