Name: *

LinkedIn Profile *

Role:

Phone: *

Why are you wanting to be mentored at this point in your career? *

What are your career aspirations/goals: One year from now: *

Three years from now: *

What do you specifically want to achieve in your professional/personal life that you feel a Mentor could support you with? Please be specific. Goal One: *

Goal Two: *

Goal Three: *

What has been your biggest challenge to date in your career? *

Please specify the professional background (skills/experience) you would ideally like in your mentor (eg. Risk management, negotiation, people management etc.) *

Describe your communication style, including how you tend to process information and make decisions. *

Describe the personal values and vision that you are looking for in your mentor: *

Describe the communication style and decision-making style that you are looking for in a mentor:

Describe the qualities of a mentor you should not be matched with.

What are the key things that you bring, as a mentee, to this program?

Please use this space to let us know about anything else you feel is relevant as we consider your application. *

If required, are you happy to participate in the program via FaceTime/Zoom type meetings if face-to-face meetings cannot occur?” *