Mentee Survey

Please complete the following details to submit your interest as a Mentee in our Emerging Leaders Mentoring Program.

Name:

Contact Phone Number:

Email:

Area of residence (city/state):

Gender: Female
Male

Date of Birth:

Organisation:

Position:

Desired Area of Expertise in T&L of Mentor:

In what areas do you seek development?:

What expectations do you have for this Mentor Program?:

Academic Interests / Career Interests:

Please list your Hobbies:

Additional Comments:

Commitment Agreement:

I am committed to open and honest communication in my mentoring relationship. I will discuss and attempt to resolve any conflicts with my mentee as they arise. I will ensure that any issues discussed are held in confidence. I will contact the program officer with any questions, concerns, or suggestions that may arise. I acknowledge that this information will be shared with my Mentor.

I agree: Yes
No

Sectional Partners

Follow us on

Facebook

Twitter