EIANZ WA Division 2026 Mentoring Survey | Mentor

Thank you for expressing an interest in becoming a mentor in the EIANZ WA Division 2026 Mentoring Program.

Mentors and mentees will be matched based on the information provided in this expression of interest and after a speed dating matching event. Placement on the program cannot be guaranteed.

The Mentoring Program Coordinator may contact you to discuss your expression of interest or request further information to assist in the matching process.

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* 1. Contact Details

Name

Position title

Organisation

Email address

Work phone number

Mobile phone number

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* 2. What would you like to achieve by participating in the mentoring program? E.g. networking opportunities, career guidance/goal setting, coaching, communication, knowledge sharing.

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* 3. Please describe any previous involvement in formal or informal mentoring relationships (if applicable):

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* 4. Please provide a short overview of your qualifications, work history, skills and experience:

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* 5. Please outline any affiliations with networks and professional memberships or associations.

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* 6. Please write a bio which will be used in the speed matching information booklet (max 100 words)

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* 7. Overall, please list the 3 things you will bring as a mentor to the Mentoring Program.

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* 8. Please indicate if you prefer to mentor a mentee from the following categories. (whilst every effort will be made to match mentors based on their preferences, this cannot be guaranteed).

Male

Female

A gender not listed here

Experience level | Early in career (2-4 years)

Experience level | Established career (5-7 years)

I am happy to be matched with any suitable mentee

Culturally diverse (please specify)

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* 9. Please provide any other relevant information to support your application

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* 10. Mentor's agreement
By expressing interest in the WA Division 2026 mentoring program, I agree / acknowledge the following (please read all statements below and tick check boxes to agree).

The information contained on this form will be used for matching purposes

Every effort will be made to match me with a suitable mentee based on my skills, objectives and preferences however, matching and placement on the program cannot be guaranteed

I will abide by the Mentoring Guidelines and maintain confidentiality with my mentee and other program participants

I will actively drive the relationship including scheduling meetings with my mentee as negotiated

I will maintain open and honest communication with my mentee

I will maintain contact with the mentoring program coordinator

I will attend any events associated with the program

I will participate in an evaluation of the program

EIANZ WA Division 2026 Mentoring Survey | Mentor

Question Title

* 1. Contact Details

Question Title

* 2. What would you like to achieve by participating in the mentoring program? E.g. networking opportunities, career guidance/goal setting, coaching, communication, knowledge sharing.

Question Title

* 3. Please describe any previous involvement in formal or informal mentoring relationships (if applicable):

Question Title

* 4. Please provide a short overview of your qualifications, work history, skills and experience:

Question Title

* 5. Please outline any affiliations with networks and professional memberships or associations.

Question Title

* 6. Please write a bio which will be used in the speed matching information booklet (max 100 words)

Question Title

* 7. Overall, please list the 3 things you will bring as a mentor to the Mentoring Program.

Question Title

* 8. Please indicate if you prefer to mentor a mentee from the following categories. (whilst every effort will be made to match mentors based on their preferences, this cannot be guaranteed).

Question Title

* 9. Please provide any other relevant information to support your application

Question Title

* 10. Mentor's agreementBy expressing interest in the WA Division 2026 mentoring program, I agree / acknowledge the following (please read all statements below and tick check boxes to agree).

* 10. Mentor's agreement
By expressing interest in the WA Division 2026 mentoring program, I agree / acknowledge the following (please read all statements below and tick check boxes to agree).