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ANZUP Mentorship Program – Mentor Application
1.
What is your current role/title
2.
What is your Organisation / institution
3.
What is your email address?
4.
How many years of professional experience do you have in your field?
3–5 years
6-10 years
11-15 years
16-20 years
20+ years
5.
Briefly describe your current role and any previous roles relevant to mentoring (including duration)
6.
Have you previously been a mentor? Please provide details (formal or informal)
7.
In which areas could you support a mentee? (select up to 5)
Navigating a career in clinical trials/research
Understanding personal strengths and development areas
Leadership and team development
Communication and presentation skills
Time management and prioritisation
Stakeholder engagement and collaboration
Project or trial management
Managing challenging conversations
Problem solving and decision making
Working within multidisciplinary teams
Career progression and pathways
Work–life balance and resilience
Other (please specify)
8.
Where do you feel you can add the most value as a mentor? (select up to 2)
Building confidence
Career development and progression
Leadership capability
Providing guidance and support
Other (please specify)
9.
Is there anything else that would help us match you with a mentee
10.
How did you hear about the ANZUP Mentorship Program?
ANZUP email or newsletter
ANZUP ASM or event
Colleague or peer recommendation
Social media
ANZUP website
Other (please specify)
11.
I understand the expectations of being a mentor in the ANZUP 6 month Mentorship Program and will:
- Commit to meeting with my mentee approximately once per month
- Support and encourage my mentee’s development
- Maintain confidentiality and respect privacy
- Engage with any program resources provided
- Not use the program for recruitment or personal gain
Yes
No
12.
I confirm I will communicate openly with my mentee and the program coordinator if my availability or commitment change
Yes
No
