HFMA Mentoring Application Form

1. Personal Information
Page 1 of 3

We want to ensure members get the very best value from our mentoring scheme and we therefore need you to complete the application form in as much detail as possible. This will assist us in being able to match you up with a suitable Mentor and for your matched Mentor to understand what you are looking for from a mentoring relationship.

Important personal data notification: Should you be assigned a mentor, this application form, including your name, email address and contact information will be shared with said mentor. These are details we need to share to complete the contract between both parties, and ensure the best possible experience for both mentor and mentee. HFMA will not share this information with any other third parties.

Personal Information *

Title	*
First Name	*
Surname	*
Gender	*
Job Title	*
Banding Level	*
Employer (if self-employed, name of company/trading name)	*
HFMA Membership Number/Code (log in on the HFMA webpage and click on your name in the top right hand corner, then click 'HFMA Membership Portal', log in again and your code will be displayed)
Work Address (including postcode)	*
Work Telephone Number
Mobile Number	*
Email Address	*

CLICK HERE to visit the HFMA website.

Collection of this information is subject to the HFMA privacy policy which is available from HERE.

Healthcare Financial Management Association (HFMA) is a registered charity in England and Wales, no 1114463 and Scotland, no SCO41994
HFMA is also a limited company registered in England and Wales, no 5787972.

HFMA Mentoring Application Form

1. Personal InformationPage 1 of 3

Personal Information *

1. Personal Information
Page 1 of 3