2016 South Australian Mentoring ProgramInterest Form

MentorApplication

MentoringMissionStatement:

Inspire others to continually strive forhigher levels ofperformance throughcreative andstrategic methods that are always focused in achieving the intended goals.

Iaminterestedinactivelyparticipatinginthe2016NAWICMentoringProgram.IherebysubmitthefollowingdetailswhichIunderstandwillbeusedbytheMentoringSub-Committeetopairmeforthementoringprograminordertoobtainthebestoutcomeformyindividualgrowthandgoals.

FirstName / LastName
E-mail / ContactphoneNo.
PreferredMethodof
Contact(Pleasecircle) / EmailPhone / IfPhone,PreferredTimeofContact
CompanyName / City/Locality
NAWICMember(Pleasecircle) / YesNo / MembershipNumber(ifknown)

CompanyPosition

CompanyName / City/Locality
Profession / MostrecentEducation/Qualification
JobTitle / LengthintheIndustry
Pleaseprovideabriefoverviewofyourcurrentroleandresponsibilities
PreviousRoles/Professions
Whatareyourstrengths
Achievements/Other
Qualifications / Listanyadditionalinvolvementyouhavewithoutsideorganisations,otherqualificationsandrecentnotableachievements
Whatskillsandexperiencecanyouofferamentee
Pleasenumberinorderofimportance(nominateatleast3).
1beingmostimportant / Architectural / ESD(Environmentally
SustainableDesign) / PersonalDevelopment/CareerPlanning
BusinessPlanning/Strategy / LargeCompany
Experience / ProjectManagement
Experience
CommercialExperience / LegalExperience / StartingOwn
Business
Consultancy / Management/Leadership
Experience / Trades
EngineeringExperience / OverseasExperience / Other
IfOther;pleaseconfirmdetails.(i.e.sitebased,officebased,workingmother,etc)
WhatareyoulookingtotakeawayfromtheNAWICmentoringprogramme?(tohelpmatchyou) / GoalsandObjectives:(i.e.leadership,work/life,skills,careeraspirations,etc)
Iwouldlikealettersent
tomyCEO/MD/Manager/Supervisorinforming
themofmyinvolvement / YesNo
Name:
MailingAddress: / Title:

NOTE:YOUMUSTBEANAWICMEMBERTOPARTICIPATEASMENTEEINTHISPROGRAM. Please visit and go to Membership Fees & Application.

InterestformsareduenolaterthanFriday 10 June 2016.Anyformsreceivedafterthatdatewillnotbeconsideredunlesspriorarrangementshavebeenmadewiththeadministrator.

Please complete this form and email with your most recent CV to mailto:

Disclaimer:

MentorsandmenteesparticipationinthementoringprogramprovidedbyNAWICareonapurelyvoluntarybasis.Mentorsdonotchargefortheadviceandguidancetheyprovideandaccordinglytheservicesprovidedisnosubstituteforobtainingindependentprofessionalfinancial,technicalorlegaladvice.

NAWICand/orthementorswillnotbeliableforanyloss(whetherdirectorindirect,financialorotherwise)resultingfromyourrelianceonanyadvicegivenaspartofthementoringprogram.

Iagreethatanyinformationprovidedinthisformmaybesharedwiththementoringfacilitator,administrator,andMentoringSub-Committeetoassistinpairingupthementors/mentees.

Ihavereadandunderstandtheabovestatement.IunderstandthatmyparticipationintheNAWICmentoringprogramisatthediscretionofNAWIC.

Signed:

Date: