Personal Information

Name

Email Address

Phone

Current Role

Current Company

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

2. Summarise your background/career history.

3. What kind of advice, guidance or challenge you are hoping a mentor can help you with?

4. Would you prefer to have a female mentor?

Yes

No

5. Will you be able to commit to an in-person session once a month? (5.30 to 7.30pm, dates TBC)

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 week night, after business hours.

Any other comments:

THANK YOU!