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Registration Form – Mentor

Australian Institute of Geoscientists > Registration Form – Mentor

Registration Form – Mentor

    Personal details & contact

    Name*

    Address*

    City

    State

    Postcode

    Phone (mobile)*

    Phone (other)

    Email*

    Membership Number

    Membership Application ID (Eg: APP1234 - If member application is in progress)

    What program are you applying to join? *
    WAQLDNSWVICSATASDISTANCE

    Would you consider joining the Distance Program if a better pairing (experience/industry sector) could be found?
    YesNo

    Gender*
    FemaleMalePrefer not to disclose

    What is your preference if any, a male or female mentee?*
    No preferenceFemale menteeMale mentee

    Have you been a mentor before in the AIG Mentoring Program?
    YesNo

    Would you like us to use the information previously provided?
    YesNo

    EMPLOYMENT HISTORY

    Please attach a recent CV here. (Formats accepted - .pdf or .docx. Please include your full name in the file name - e.g.: 'tom-smith-cv.pdf'. Upload limit maximum 3mb.)*

    INTEREST AREAS/CAREER PATH

    What is your primary area of (professional) interest? *

    Do you have secondary areas of (professional) interest? *

    Do you have experience as a Mentor?YesNo

    What specific skills and experience would you bring to the mentoring process?

    What are your reasons for wanting to become a mentor?

    Would you be willing to mentor more than one student/graduate?
    YesNo

    You may not be approached to be a mentor in the current round of the mentoring program due to the incompatibility of mentees who apply and number of spaces available. If this is the case, are you happy for us to keep your expression of interest on file to be used in future rounds of the program?
    YesNo

    PERSONALITY

    When asked a question do you prefer to
    talk through the issues with your questioner and answer on the spotgo away and think about it before giving an answer

    How do you rank the prospect of speaking in public
    **((Terrifying) 1 2 3 4 5 (Exhilarating))12345

    In a discussion on something you feel strongly about, do you usually
    offer an opinionwait to be asked before expressing an opinionavoid offering an opinionchange the subjectfind an excuse to leave

    In a discussion on something in which you have little interest in, do you usually:
    offer an opinionwait to be asked before expressing an opinionavoid offering an opinionchange the subjectFind an excuse to leave

    Where would you rank yourself on the extrovert-introvert scale
    **((Introvert) 1 2 3 4 5 (Extrovert))12345

    You enjoy vibrant social events with lots of people
    **((Agree) 1 2 3 4 5 (Disagree))12345

    You often think about what you should have said in a conversation long after it has taken place:
    **((Agree) 1 2 3 4 5 (Disagree))12345

    You often rely on other people to be the ones to start a conversation and keep it going
    **((Agree) 1 2 3 4 5 (Disagree))12345

    You rarely worry if you made a good impression on someone you met
    **((Agree) 1 2 3 4 5 (Disagree))12345

    You are more of a detail-oriented than big picture person
    **((Agree) 1 2 3 4 5 (Disagree))12345