Expression of Interest Application - Roses in the Ocean MENTOR
This form will allow you to express an interest in becoming a Mentor with Roses in the Ocean
Date of Application
Your answer
Hi - thanks for connecting with us!
Thank you so much for reaching out and showing interest in becoming involved as a Mentor within the Roses in the Ocean Mentoring Program.

Please ensure you have read the ‘Am I Ready?’ document (found on our website) before completing this Expression of Interest.

Applications to be a Roses in the Ocean Mentor are accepted at any time of the year.

Following receipt of your Expression of Interest, a member of the Roses in the Ocean team will contact you to have a conversation about you, your lived experience and how you feel you are ready to become a Mentor.

How did you hear about the Mentoring Program?
Full name
Your answer
Year of Birth
Your answer
Street Address
Your answer
State
Your answer
Best day time contact number
Your answer
Mobile Number
Your answer
Email address
Your answer
Alternative contact person
As your safety is our main concern we would like to have a trusted alternative contact for you. In the event that we need to contact a support person for you or are having issues contacting you, we know who to call. Please include their name, relationship to you, and their contact details such as mobile and email.
Your answer
Do you identify as a member of any of these groups?
Please select all that apply to your lived experience
Required
Briefly describe your lived experience
Your answer
Briefly outline other experience that supports your application to be a Mentor.
Your answer
What is it that you would like to achieve by becoming a Mentor?
Your answer
Describe what you do on a daily/weekly basis to nurture and take care of yourself.
Your answer
Please read each statement and indicate your agreement before submitting your application.
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