MATES Mentor Application Watch the MATES Video MATES Mentor Application Form First Name * Surname * Gender * Male Female Unspecified Your age group * 18 - 25 years 26 - 40 years 41 - 65 years Over 65 This is helpful when we are matching you to a mentee Home Address Phone Contact Email * Which of the following describe your situation? Retired Employed part-time or casual Employed full-time Looking for work Other If you are employed, please provide your employer contact details" If you are not employed, please go to the next question Your current employment position Other interests Please list other areas of expertise or interest. Work or Community Experience Please list previous work experiences or community involvement. Include name of organisation, positions held and period of involvement. Training and expereince List any training or expereince you have had which may enhance your role as a mentor e.g. scout/guides leader, teacher's aide, sports coach... Please provide names and contact details of two referees. You will not be able to complete the application form unless you provide the name and phone number of at least one referee. Any information the MATES Mentoring Program gathers from these referees will be held as confidential and not released to you, the applicant. Please note: it will be the responsibility of the applicant to inform the referees listed that they will be participating in this personal reference check and will be contacted by the MATES Program Coordinator. Mentor Referee 1 * Referee 1 Phone No. * Referee 1 Email: Mentor Referee 2 Referee 2 Phone: Referee 2 Email Your preferred meeting times Monday Tuesday Wednesday Thursday Friday Please indicate the day/s that would be most convenient for you to meet with your mentee. Do you speak any language other than English? Yes No If Yes, which languages? What are some favourite things you like to do with other people? What were your favourite subjects at school? What are your favourite subjects/books to read about? What is/was your career/job and how did you choose that field? What is one goal you have set for the future? If you could learn or try a new skill or interest, what would it be? See the list below if necessary. Is there somewhere you would really like to go one day, or something you would like to see? Which person do you admire and why? Describe your ideal Saturday. Please tick all the activities from the list below which you are interested in Biking Science Music Golf Cooking Yabbying Library Boating Sports Movies Computers Photography Gardening Travelling Art/Painting Craft Animals/Pets Shopping Exercise Board Games Fishing Swimming Internet Elaborate on your above choices or list other hobbies or areas of interest. The information you provide about yourself will be used to find a good match for you. We aim to match mentors and metees who have some similar interests. Preferred Mentoring Location Please indicate if you have a preference to mentor a student in a particular school or town. Working with Children Check * I have a current Working with Children Check I agree to undertake a Working with Children Check It is mandatory for all MATES mentors to have a current Working With Children Check. Declaration * I declare that the information in this Mentor Application is, to the best of my knowledge, correct. Media Consent * Yes No I agree to allow the MATES Mentoring Program to use any photographic image, film or voice recording taken of me whilst participating in the mentoring program for promotional purposes. These images may be used by the school or the Wimmera Southern Mallee Local Learning and Employment Network (WSMLLEN) to promote the MATES Mentoring program through print, advertising, digital and social media. Date Submitted Type today's date here
