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. Can you identify any key experiences that may be helpful for relating to a mentee? (eg having managed workplace conflict, work/life balance, previous mentoring)

4. Have you participated in this program before?

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.

Any other comments:

THANK YOU!