Mentor Registration – Group Activities

Mentor Registration - Group Activities

Mentor Registration - Group Activities

This form is used to collect Mentor details for planned group activities

Name
Name
First
Last
What is your preferred pronoun?
Are you Aboriginal and/or Torres Strait Islander?
Do you speak any language other than English?
Which of the following describe your situation?
If applicable, please provide your employment details below.
Contact Person
Contact Person
First
Last
Please tick all the activities from the list below which you are interested in
REFEREES: 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.
Referee 1 Name
Referee 1 Name
First
Last
REFEREE 2
REFEREE 2
First
Last
WORKING WITH CHILDREN CHECK
It is mandatory for all MATES mentors, volunteers and staff of Wimmera Southern Mallee LLEN to have a current Working With Children Check.
MEDIA CONSENT
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.
PRIVACY - WSMLLEN’s volunteer programs collect and administer a range of personal information for the purpose of operating the programs. It is committed to protecting the privacy of personal information it collects, holds and administers. WSMLLEN recognises the essential right of individuals to have their information administered in ways that they would reasonable expect – protected on one hand and accessible to them on the other. WSMLLEN is bound by Victorian privacy laws, the Information Privacy Act 2000 and other laws which impose specific obligations about handling information. We have adopted the principles contained in the Victorian privacy laws as minimum standards. In broad terms this means that WSMLLEN: Collects only information that is needed to effectively run the volunteer programs; Ensures that all program participants understand why we collect information and how it is administered; Use and disclose personal information only for our primary function or a directly related purpose, or for any other purpose only with the person’s explicit consent; Store personal information securely, protecting it from unauthorised access; Give participants access to their own information and the right to correct it.
CHILD SAFE STATEMENT - Wimmera Southern Mallee LLEN is committed to promoting and protecting the interests and safety of children. We have zero tolerance for child abuse. Everyone working at Wimmera Southern Mallee LLEN is responsible for the care and protection of children and reporting information about child abuse. Child protection is a shared responsibility between the Wimmera Southern Mallee LLEN, all employees, workers, contractors, associates, volunteers and members of the Wimmera Southern Mallee LLEN community. The Wimmera Southern Mallee LLEN ‘Volunteer Child Safe and Duty of Care Policy’ helps to ensure that all parties are aware of their responsibilities for identifying possible occasions for child abuse and establishes controls and procedures for preventing such abuse and/or detecting such abuse when it occurs.
DECLARATION