2021 Mentor Application

Data Processing Consent

In order to send information to you about InspirED 2021 as it becomes available we will collect personal information about you. Please click here for information on the Audiology Australia privacy policy.

Without your consent for your details to be collected we will not be able to send you updated information about InspirED 2021. You will be redirected to the InspirED 2021 website. Please confirm that you give us consent to collect personal information about you to proceed with the registration form.

Data Processing Consent

I give consent

I do not give consent

Contact Details

First Name

Last Name

Title

Organisation

Position

Member Number (AudA)

Email Address

Verify Email Address

Work

Mobile

Primary Address

Address

City

Country

State

Postcode

Summary

Please check your application details carefully below.

Confidentiality Agreement

For a mentoring relationship to develop, the mentor and the mentee must feel that discussions of private issues or problems are being handled with discretion.

The purpose of this agreement is to protect the mentor and mentee from a breach in confidentiality during the mentoring process. By agreeing to this meeting you are confirming you:

agree to hold confidential conversations in confidence and to not violate the trust that is required for this relationship to be effective and powerful
understand all information exchanged in this relationship is strictly confidential and not for external use

I agree to the Confidentiality Agreement

InspirED 2021 ConnectED - Mentor Application Form

Data Processing Consent

Data Processing Consent

Contact Details

Contact Details

Primary Address

Which location will you be attending?

Adelaide Hub

Brisbane Hub

Melbourne Hub

Perth Hub

Sydney Hub

About You

Which university did you graduate from?

What year did you graduate?

What best describes the nature of your primary (most hours spent) workplace?

If you have selected other for nature of your workplace, please specify

Qualifying Questions

In matching with someone, what would be some areas that you are most passionate about?

Can you outline 3 key strengths that could be beneficial in the context of this meeting?

Previous Mentoring Experience

Have you been a mentor before?

Have you had a mentor before?

Potential for Ongoing Engagement

While there is no expectation on either party to keep in contact beyond this initial session, would you be open to an ongoing mentee/mentor relationship?

Summary

Confidentiality Agreement

Thank you for your mentor application!

2021 Mentor Application - unregistered

InspirED 2021 ConnectED - Mentor Application Form

Data Processing Consent

Data Processing Consent

Contact Details

Contact Details

Primary Address

Which location will you be attending?

Adelaide Hub

Brisbane Hub

Melbourne Hub

Perth Hub

Sydney Hub

About You

Which university did you graduate from?

What year did you graduate?

What best describes the nature of your primary (most hours spent) workplace?

If you have selected other for nature of your workplace, please specify

Qualifying Questions

In matching with someone, what would be some areas that you are most passionate about?

Can you outline 3 key strengths that could be beneficial in the context of this meeting?

Previous Mentoring Experience

Have you been a mentor before?

Have you had a mentor before?

Potential for Ongoing Engagement

While there is no expectation on either party to keep in contact beyond this initial session, would you be open to an ongoing mentee/mentor relationship?

Summary

Confidentiality Agreement

Thank you for your mentor application!

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