NAWIC ACT | MENTORING PROGRAM
Application for Mentors

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* Personal Information

Name

Email Address

Phone

Current Role

Current Company

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

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* 2. Can you summarise your background/career history?

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* 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)

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* 4. Have you participated in this program before?

Yes

No

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

Yes

No

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* 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.

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* Any other comments:

THANK YOU!