Accelerate@Upstairs Mentor program - mentors Mentor expression of interest Question Title * 1. Please provide your email address Question Title * 2. Please provide your name (first and last) Question Title * 3. What is your primary role? Question Title * 4. In what sector of industry do you work? Agriculture, forestry and fishing Mining Manufacturing Electricity, gas, water and waste services Construction Wholesale trade Retail trade Accommodation and food services Transport, postal and warehousing Information media and telecommunications Rental, hiring and real estate services Professional, scientific and technical services Administrative and support services Public administration and safety Education and training Health care and social assistance Arts and recreation Other (please specify) Question Title * 5. How many years have you formally mentored? 0 3 6+ years Clear i We adjusted the number you entered based on the slider’s scale. Question Title * 6. What area do you want to mentor in? Career Education Professional conduct Professional skills Other (please specify) Question Title * 7. Would you prefer to mentor in-person or remote (i.e phone or online)? in-person remote either in-person or remote is fine Question Title * 8. Do you have access to a stable internet or phone connection for remote mentoring? Yes No Question Title * 9. What do you want to get out of this program? Question Title * 10. Do you give permission for your contact details to be sent to your matched mentee? Yes No Question Title * 11. Do you consent to the Upstairs including any feedback you provide or specific examples from your mentoring experience in promotional material? Yes No Done