Brosnan Services

African Visitation and Mentoring Program (AVAMP)

Volunteer Mentor Application Form

Section 1 Contact Details

About Yourself
Name
Alias Names
Gender
DOB
Cultural Identity
Place of Birth
Address
Street
Suburb
State
Telephone / Home / Work / Mobile
Email
Emergency Contact
Name
Relationship
Telephone / Home / Work / Mobile
Additional Information
Drivers Licence / Yes No / Own Motor Vehicle / Yes No
Access to Public Transport / Yes No

Section 2. Academic experience

Current/most recent academic experience
Establishment
Period of Study
Qualification title
Details
Previous qualifications
Establishment
Period of Study
Qualification title
Details

Section 4. Voluntary Experience

If you have worked in a voluntary capacity, please complete the following:

Voluntary Position 1
Organisation
Position
Period of service
Key Duties
Voluntary Position 2
Organisation
Position
Period of service
Key Duties

Section 5. Legal Issues

5.1 / Have you ever been convicted of a criminal offence? / Yes No
5.2 / Have you ever served a term of imprisonment? / Yes No
5.3 / Do you have any outstanding legal matters? / Yes No
5.4 / Are you prepared to undergo a Police Record Check? / Yes No
5.5 / Are you prepared to undergo a Working with Children Check? / Yes No
Answering ‘yes’ or 'no' to any of these questions will not necessarily disqualify you from becoming a mentor

Section 6. Becoming a mentor

Please answer the following questions
1. Why do you want to become a mentor for this program?
2. Do you have any experience working with people from African countries?
3. Please list your hobbies and interests

Section 8. Availability

8.1 / When are you available fortraining and meetings? / weekday days / weekday nights / weekends
Monday Tuesday Wednesday
Thursday
Friday / Monday Tuesday Wednesday
Thursday Friday / Saturday
Sunday
8.2 / Would you be available to train for two days – Saturday 6th and Saturday 13th of May / Yes No Unsure
8.3 / Will you require any aids to assist you to train? / Yes No
If 'yes' to 8.3, please provide details:
8.5 / Are you available to attend two meetings per year? / Yes No Unsure
8.6 / Are you prepared to make a 12 month commitment to the program? / Yes No Unsure

Section 9. Matching

Mentoring preferences
9.1 / I am interested in working with / Men
Women / from
Sudan
Somalia
Ethiopia
Eritrea / Congo
Kenya
Sierra Leone
Any
Other:
9.2 / I am interested in working with ages / 18-24 25-3031-40 41+ Any
Mentoring availability
9.3 / When are you available to mentor? / Weekday days / Weekday nights / Weekends
Monday Tuesday Wednesday
Thursday
Friday / Monday Tuesday Wednesday
Thursday
Friday / Saturday
Sunday
9.4 / Are there any other details you would like to specify?

Section 10. Referees Details

(Please list at least two)

Referee 1. Professional
Name
Telephone
/ Home / Work / Mobile
Email
Relationship to you / (e.g. lecturer, employer)
Referee 2. Personal
Name
Telephone
/ Home / Work / Mobile
Email
Relationship to you / (e.g. friend, colleague)

1