LEAP Mentor Application Form Sem 1/2017

Application Form

Please indicate which program you would like to apply for*

Refugee mentoring Pacific Islander mentoring

Note: You can select both programs if you wish to be considered for both of them. Please note if successful you will only be allocated to one

Personal Details

Name*

First Name

Last Name

Preferred name

Address*

Address Line 1

Address Line 2

City

State

Postcode

Gender*

Date of birth*

Preferred telephone number*

Alternative telephone number

Preferred email address*

Student email address*

Please select the primary cultural or ethnic group that you identify with*

If "Other" please specify the cultural or ethnic group

Are there any other additional cultural or ethnic group/s that you identify with?

Yes No

If yes, please provide details

Languages spoken*

Dietary requirements*

Academic Details

Student number*

Which year of study are you currently in?*

Faculty*

Faculty of Arts Faculty of Business and Economics Faculty of Human Sciences Faculty of Medicine and Health Sciences Faculty of Science and Engineering

If combined degree, please tick all relevant faculties

Degree Title*

e.g. Bachelor of Arts

How did you hear about the opportunity?*

If "Other" please specify

Application Information

What high school did you attend?*

What was your pathway into university*

ATAR TAFE/VET SIBT Transferred from another university and/or degree Work experience Other:

Tick all those relevant

If "Other" please specify

Why would you like to be a mentor*

Maximum of 1000 characters allowed

Do you have any previous mentoring experience?*

Yes No

If yes, please provide details of previous mentoring experience

What relevant experience and skills do you have to offer as a mentor to high school students from refugee backgrounds?*

Maximum of 1000 characters allowed

What do you think are the major challenges facing young people from refugee or Pacific Islander backgrounds?*

Maximum of 1000 characters allowed

Any other information or comments you would like us to consider?

Maximum of 1000 characters allowed

Program Requirements

To participate in the LEAP Macquarie Mentoring Program, I understand that I need to:*

Be available for 1 day between 1 - 3 February 2017 for a group interview Undertake a satisfactory 'working with children' check prior to the commencement of training Complete online training and attend face to face training on one day between 23 - 24 February 2017 Be available for 3-4 hours at a fixed time per week (this includes travel time to / from schools) from 6 March - 2 June 2017 Be available to participate in University Experience Day on 12 May 2017, from 9:00am – 2:00pm Attend 1hr feedback session in the week of, 15 - 19 May 2017