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* 1. Name

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* 2. Program Commitment: In applying for participation in the Association of Corporate Counsel (ACC) Australia Mentoring Program, I confirm that:

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* 3. I understand that if a suitable mentor is confirmed for me a non-refundable administrative fee will apply (tick the option that applies to you)

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* 4. How did you hear about this program?

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* 5. Phone - Mobile

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* 6. Phone - Business hours

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* 7. Email address

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* 8. Current Position Title

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* 9. Current Company/Organisation

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* 10. Geographical location (town, city or suburb)

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* 11. State

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* 12. Years of overall legal experience

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* 13. Years of in-house experience

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* 14. Other employment experience outside of law

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* 15. Please paste the link to your LinkedIn or other online bio here (if you do not have an online profile, please email your CV to mentoring@accglobal.com)

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* 16. In what industries do you have an interest?

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* 17. In which areas of specialisation do you have an interest?

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* 18. In which of these professional development areas are hoping to improve with the help of your mentor?

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* 19. What motivates you to be part of this mentoring program?

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* 20. What do you hope to achieve through participation in this program?

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* 21. How important is geographical location to your mentor choice?

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* 22. What importance does industry background have in your mentor selection?

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* 23. Please add any other information that may help us make the best possible match and/or note any special requests you have regarding how you are matched

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* 24. Do you require a conversation with the program facilitator prior to match selection?

Thank you for taking the time to complete this application.

The Program Facilitator, Karina Butera, will be processing the applications after the close-off date (11 December 2019). You can expect to hear from Karina by mid-January.

If you are located in the Sydney or Melbourne area, please diarise of the relevant opening event now:

Please diarise the opening program webinar 12.00-12.45pm on 5 February 2020 (login details will be provided at a later date). 

Please note, to ensure a positive experience for both mentees and mentors, we will only match you with a mentor who is believed to be a strong fit. If a suitable match is not found for you, Karina will notify you by the end of January and you will have the option to be placed on the waiting list for the next program.

If you have any questions or concerns, please contact Karina at k.butera@accglobal.com or on 0413 041458.

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