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Please complete this form to lodge an application for the HPE Teacher Mentor Program 2024. This program is available for first year teachers and is due to commence at the beginning of Term 2.

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* 1. Name

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* 3. Contact number

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* 4. School

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* 5. Which of the following levels do you teach?

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* 6. Date of first teaching placement

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* 7. Statement to support your application, why do you want to be included in the ACHPERWA Mentor program?

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