Become a Mentor

To enable us to identify that you have the qualities to be a mentor we require you to complete the following questions and sign the terms and conditions section on the last page.

Part 1: Personal Information
Name
Street Address
City
State
Post Code
Phone
Mobile
Fax
Email
Age
Date of Birth
Gender
Languages Spoken
Part 2: Place of Residence

Please list other places and dates of residency during the past 5 years.

Suburb/Town State Dates Residing At This Residence
Part 3: Employment and Club / Association History

Please provide employment information for the past five years, with most recent position held first. Please ensure you include any mentoring experience or training completed.

Employer / Club / Association
Dates
Position held
Phone
Fax
Duties / Position
Employer / Club / Association
Dates
Position held
Phone
Fax
Duties / Position
Employer / Club / Association
Dates
Position held
Phone
Fax
Duties / Position
Employer / Club / Association
Dates
Position held
Phone
Fax
Duties / Position
Part 4: Mentor Survey

Please answer all of the following questions as completely as possible. If more space is needed, use an extra sheet of paper or write on the back of these pages. Please note if you are successful in our selection process the question marked with * will be shared with mentees to assist in matching you with a suitable mentee.

Please list:
Please list:
Part 6: Personal References

Please list the names, addresses, and phone numbers of three people you would like to use as character references (only people you have known for at least a year). Include at least one relative. Any information True Blue Dreaming Youth Mentoring Program gathers from these references will be held as confidential and not released to you, the applicant.

yrs
yrs
yrs
Part 7: Terms and Conditions

The True Blue Dreaming Youth Mentoring Program appreciates your interest in becoming a mentor.

Please read this carefully before signing and sign each statement below to indicate you understand and agree with the terms outlined below: