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* 1. Contact Details:

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* 2. What are you applying as?

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* 3. How many years of work/industry experience do you have?

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* 4. What is your primary work location i.e. Melbourne, Regional (please specify) or FIFO (state location) and if so, where?

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* 5. What is your job title?

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* 6. Give a brief description of yourself - personal and professional (100 words max)

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* 7. What are your formal qualifications/highest degree of education?

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* 8. About you: What are your key competencies?

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* 9. Mentees: What key competencies would you like in a mentor? (Mentors only: please skip to the next question).

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* 10. Mentees: What are your short term professional development goals?

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* 11. Mentees: What are your long term professional development goals?

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* 12. Mentors: What are your mentoring program goals? (Mentees only: please skip to the next question).

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* 13. Is there anything else that you would like to tell us or that we should know about you?

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* 14. Mentees - do you give permission for WIMnet Vic to add you to a WhatsApp Mentee group?

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* 15. Program participation - In consideration for my acceptance into the program, I release the Australasian Institute of Mining and Metallurgy (AusIMM) and the program coordinators from any and all claims which I may have against any of them arising from or in connection with my participation in the program.

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