Request for a County Going Away with Mentor

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If you are planning to start your Going Away With Scheme, please ask your commissioner to complete a Notification to County form.

Once submitted we will identify a mentor to support you.

Going Away with Scheme – Request to County to appoint a Mentor and Assessor

This form should be completed by the Commissioner (or their deputy) who is responsible for approving Residential Event Notification Forms.

We ask that this form is completed before a residential event is planned so that a mentor can be assigned before the qualification is started on.

Commissioner's Name *

Email *

Phone Number *

Division *

Please appoint a mentor and assessor for the following leader who wishes to gain a Licence or additional modules.

Leader's Name: *

Membership Number *

Leader's Email *

Leader's Phone Number *

Unit (including section): *

If the leader is adding additional modules, then please indicate which modules she already has and which she is adding.

Going Away Licence (Modules 1 to 4)

Already has
Would like to add

Catering (Module 5)

Already has
Would like to add

Programme (Module 6) - Brownies

Already has
Would like to add

Programme (Module 6) - Guides

Already has
Would like to add

Programme (Module 6) - Rangers

Already has
Would like to add

Facilities (Module 7)

Already has
Would like to add

Camping Equipment (Module 8)

Already has
Would like to add

For leaders wishing to gain a licence:

I can confirm the leader has completed the Leadership Qualification and currently holds an active role as a Leader, Assistant Leader, Commissioner or Adviser

If the leadership qualification / leader development programme has not yet been completed then please advise when it is expected to be. (It must be completed before the residential event):

I can confirm the leader has completed 'Safe Space 3 / Safer Guiding’ and that it will be valid at the time of the residential event (if the leader has a date in mind).

Please state below when the leader is thinking of doing their residential (if known) (e.g. summer next year) and any thoughts they currently have about the type of event (e.g. sleepover / indoor holiday / camp). If any plans have already been made then please add the details here:

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