INDIGENOUS MENTORING PROGRAM REGISTRATION FORM

Please complete and send to –

Mentor Name
Mentor Email Address
Mentor Contact Number
Mentor Agency or Department
Mentor Branch/Selection/Group
Select / Mentor Location (state and region)
NSW – Eastern NSW (Sydney, Newcastle, Wollongong, Nowra, Batemans Bay, Tamworth
NSW – Western NSW (Dubbo, Wagga Wagga, Orange, Griffith, Walgett, Bourke, Wilcannia, Broken Hill, Lake Cargelligo)
QLD – South Queensland (Brisbane, Rockhampton, Toowoomba, Woorabinda)
QLD – Gulf & North Queensland (Townsville, Mount Isa, Doomadgee, Mornington Island)
QLD – Far North Queensland (Cairns, Thursday Island, Aurukun, Hope Vale, Mossman Gorge)
VIC – Victoria (Melbourne, Bulla, Shepparton, Mildura, Wodonga)
TAS – Tasmania (Hobart, Launceston, Devenport, Burnie)
SA – South Australia (Adelaide, Port Augusta, Ceduna, Amata, Umuwa, Mimili)
NT – Top End & Tiwi Islands (Darwin, Katherine, Wurrumiyanga, Bulman, Jilkminggan, Elillott, Borroloola, Numbulwar, Robinson River)
NT – Central Australia (Alice Spring, Tennant Creek, Epenarra, Ali Curung, Ampilatwatja, Yuendumu, atitjere, Palumpa, Nauiyu, Sanata Teresa, Yulara)
NT – Arnhem Land & Groote Eylandt
WA – Greater western Australia (Perth, South Headland, Karratha, Canarvon, Meekatharra, Geraldton, Kalgoorlie)
WA – Kimberly – (Broom, Beagle Bay, Derby, Halls Creek, Kununurra)
ACT – Canberra & Surrounds
Mentor City or Town of Location
Mentor APS Classification (APS 4 to SES)
Select / Mentor Gender
Female
Non-Binary
Male
Do not identify
Select / Mentor age group
Under 25
26 - 35
36 - 45
46 -55
56+
Select / Mentor heritage and cultural proficiency
I identify as an Aboriginal person
I identify as a Torres Strait Islander person
I am non-Indigenous and have limited cultural awareness
I am non-Indigenous and have intermediate cultural awareness
I am non-Indigenous and have advanced cultural awareness
I am non-Indigenous and have no cultural awareness
Mentor job title (Project Manager, Legal Officer, etc..)
Select / Mentor sector or industry of experience (3 options
Accounting and Finance
Administration
Communications and Marketing
Compliance and Regulation
Development Programs
Engineering and Technical
Health
Human Resources
ICT
Information and Knowledge Management
Intelligence
Legal and Parliamentary
Monitoring and Audit
Organisational Leadership
Project and Program
Research
Science
Service Delivery
Strategic Policy
Trades and Labour
Other
Select / Mentor areas of expertise (4 options)
Adapting to change
Balancing cultural heritage and working in the APS/Commonwealth
Balancing work/life commitments
Building resilience and managing difficult situations
Communicating effectively in the APS
Developing leadership and management skills
Job and interview coaching
Increasing motivation and re-engaging in my current role
Independence and decision-making skills
Influencing others
Navigating difficult conversations at work
Navigating the Australian Public service
Networking and engagement
Select / Mentor experience in leadership
I currently, or have, managed a large group of people
I currently, or have, performed in a leadership role
I have not performed as a leader before
Select / Mentor preference(s) in gender of Mentee (multiple options)
Female
Non-Binary
Male
No preference
Select / Mentor preference of face-to-face contact (1 option)
1 time every 4 weeks (minimum)
1 – 3 times every 4 weeks
3+ times every 4 weeks
Flexible
Select / Mentor preference of email/phone contact (1 option)
15 -30 minutes in total over a 4 week period
30+ minutes over a 4 week period
As a Mentor I can bring to this program (please provide an example of what your contribution to the program will be)
Select / My commitment to the APSC and to my Mentee is (select each box to confirm)
I will read the Terms and Conditions of the program once my registration is processed
I will read the Privacy Policy of the program once my registration is processed
I will read the Confidentiality Policy of the program once my registration is processed
I acknowledge that I may not be allocated a partner immediately after my registration is complete
I acknowledge that if I participate in this program, I do so during business hours
I will follow the instructions set out by the APSC
I will complete questionnaires issued by the APSC during the Mentoring partnership
I acknowledge that I will undertake the online training and listen to podcast/audio files developed by the APSC after I have been matched