Personal Information

Name

Email Address

Phone

Current Role

Current Company

1. What are you hoping to get out of the mentoring program?

2. Can you summarise your background/career history?

3. What are you looking for in a mentor?

4. Would you prefer to have a female mentor?

Yes

No

5. Can you commit to an in-person session on a weeknight once a month?

Yes

No

6. Please type "I acknowledge" in the answer field to indicate that you accept and acknowledge that the mentoring workshops take place on a weeknight, after business hours.

*Please tick the box if you are applying as a site worker on EMPOWER Strathnairn.(Required.)

Yes

No

Any other comments:

THANK YOU!