Mentoring 2023 – Mentor Registration Form

1. The Basics First

First Name

Last Name

Gender

Organisation (I work for)

Job title

Current role

Mobile

Office phone number (optional)

Email

Job Function (My job function is)

Select one or add your own if not listed

Other

Industry (The industry I work in is)

Select one or add your own if not listed

Other

Work experience (Number of years work experience)

Select one

Business address

Business suburb

Business Postcode

Business state

Regional area (I am based in the following regional location)

Other

2. Tell us about yourself

Working style

If you identify with more than one, please pick the one you MOST identify with.

Biography

Work history, Professional experience, Specialist expertise, Interests/Hobbies Fun fact.

Expectations

Your lived experience

In completing the registration form, please share some specific information regarding any identities or experiences (race, sexual orientation, gender, cultural, ability/disability, neurodiversity, parenthood, carer, veteran, first in family to study, linguistic, etc) in particular that you would like to support or connect with in a Mentor - Mentee framework.

CV (optional)

Please provide a link to either your CV or LinkedIn profile.

3. Let's Talk Mentorship

Mentor level (I am a)

Mentor skills (I can provide advice on)
MAXIMISING YOUR EFFECTIVENESS (MYE)• Building reputational capital• Building meaningful networks• Communicating with purposeADAPTIVE & COURAGEOUS LEADERSHIP (ACL)• Authenticity, Values and Motivations• Leadership legacy and vision• Taking decisive action• Having courageous conversationsBUILDING AND LEADING DIVERSE TEAMS (BLDT)• Understanding and managing your own bias• Forming diverse teams for high performance• Effectively leading diverse teamsBUSINESS & TECHNICAL ACUMEN (BTA)• Creativity and innovation• Metrics and measures that matter• Business partnering (cross-functional)• Project ManagementINFLUENCE & NEGOTIATION (IN)• Effectively leading diverse teams• Championing Change• Negotiation strategies for win-win• Identifying and influencing key stakeholders

Select as many as you like.

Mentoring experience

Mentor Goals (As a mentor, I am looking to)
Assist With Career ProgressionProvide Industry InsightsHelp With Entering The IndustryProvide Professional DevelopmentEnhance My NetworkImprove Skills GapsHelp Develop A 5 Year Career PlanConnect With The Next GenerationPay It ForwardChoose Another

Select as many as you like.

Mentor Format (My 1st preference for mentoring is)

Mentor Format (My 2nd preference for mentoring is)

Session limitations (Are there any considerations which affect your availability?)

E.g. shiftwork, caring responsibilities. If yes, please provide details.

Do you need any access support to participate in these mentoring sessions (captioning of chats, copies of transcripts to process discussion later, etc)?
YesNo

4. Assessment questions

Mentoring Motivations

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