Empower Mentee Application
Empower is a youth-led mentoring and support initiative to try address the underrepresentation of refugees and other marginalised youth in higher education in New Zealand.

Empower aims to provide a mentor who is currently studying a degree that you are interested in or a graduate who has completed a degree you wish to apply for. University level mentors can provide advice about entry requirements, what it is like to study at a particular University, and other helpful tips for transitioning from High School to University. Graduate mentors can provide advice on career options for a specific degree, and other helpful advice.

The information provided in this form is to assess your suitability for the role of Mentee within Empower. In accordance with the Privacy Act 1993, the information you provide will be used for management and administration of the application process.

Are you applying to be a mentee in Auckland or Wellington? *
Full name *
Your answer
Age *
Your answer
Date of birth *
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DD
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Gender *
Main contact number *
Your answer
Secondary contact number
Your answer
Email address *
Your answer
Best contact method *
Home address *
Your answer
In what region are you able to meet your mentor? *
Are you a New Zealand Citizen/Permanent Resident? *
What is your ethnicity? *
Do you have a refugee background? This will remain confidential. *
Languages spoken *
Your answer
Do you have any health problems or dietary requirements? *
Your answer
Do you have a disability? If so, please provide details on what support you require.
Your answer
Emergency contact name *
Your answer
Emergency contact number *
Your answer
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