VOLUNTEER MENTOR APPLICATION FORM

L2P Vision Statement

L2P is a learner driver mentor program which seeks to assist young drivers who are – because of disadvantage - unable to fulfil the required supervised driving experience without significant help from the community. The program seeks to match volunteer supervising drivers with young drivers in an effort to assist these young drivers to reach the 120 hours of practice – part of the requirements for their probationary licence. The program aims at reducing accident rates of young drivers who are at higher risk of incident without the mandatory 120 hours of supervised driving practice.

L2P offers learner drivers the chance to practise their driving skills to make them better suited to the demands of a solo driver on the road and also the chance to experience a positive mentor relationship.

L2P offers volunteers the chance to help create a positive difference in the road safety of young drivers and the chance to experience a worthwhile positive mentorship with a young driver.

The L2P program provides assistance at all stages of the young learner driver’s driving experience and is capable of providing all the required driving experience from the acquisition of their learner’s permit until their probationary licence test.

The L2P program is an initiative of Vic Roads funded by TAC and is delivered in the Wangaratta region by NESAY on behalf of the Rural City of Wangaratta.

Volunteer Mentor Selection Process

Due to the nature of this program, which places volunteers as supervisors of young persons, a number of checks must be made on the volunteer, including their personal character, before they can be admitted to the program.

The Process:

Ø  Please complete the Wangaratta L2P Volunteer Mentor Application Form and return to: Wangaratta L2P Coordinator, NESAY Inc., 86-90 Rowan Street, Wangaratta, Phone: (03) 57 20 2201

Ø  The L2P Coordinator will contact you to arrange an interview that will help determine your suitability for the program and assist in the matching process as well as provide you with extra information about the program

Ø  The L2P Project Coordinator will contact the referees you provide

Ø  The coordinator will assist you to undergo a Police Check, Working with Children Check and to obtain a Driver History Report

Ø  You will also need to complete the Vic Roads L2P Volunteer Supervising Driver Training Program arranged by the L2P Coordinator. (This training is part of the selection process and satisfactory performance is required)

Ø  Upon successful completion of the training, the L2P Coordinator will contact you as soon as a suitable match has been found. You will be provided with some information on the young person and allowed time to decide whether or not you agree to the match. .An initial meeting will be arranged with yourself and the learner driver before driving sessions commence.

Personal Details
Surname: / First Name:
Home Address:
Email: / Postcode:
Preferred Phone Number: / Gender: Male / Female
Other Phone number: / Date of Birth:
Do you have any existing medical conditions that may affect your safe participation in this program?
If so, please list here:
Emergency Contact
Name: / Relationship:
Home Address:
Home Phone Number: / Mobile Phone Number:
Other Information
Driver’s Licence Number: / Expiry Date:
Learner Driver Gender Preference: (please circle) Male / Female / Either

Please provide details of two professional or personal referees who we may contact to provide a character reference. (Referees must have been known by the applicant for 12 months and must not be family members)

Name / Organisation / Position/Relationship / Phone
1
2

How many hours per week are you willing to volunteer?

Please indicate your availability for volunteering (Morning, Afternoon, Evening, All-day)

Monday / Tuesday / Wednesday / Thursday / Friday / Saturday / Sunday

To join the program you need to agree to the following: (please circle)

I agree to undertake all training relevant to the L2P program / Yes / No
I agree to undertake a Working with Children Check / Yes / No
I agree to undertake a Police Check / Yes / No
I give permission for the L2P Project Officer to undertake a Vic Roads Driver History Report on my behalf / Yes / No
I give permission for my information to be shared with Vic Roads for program evaluation and research purposes / Yes / No

Signature: Date: / /

The personal information you provide in this form is used for the purpose of registering you as a volunteer with the L2P program. The information will be used for this purpose only and will not be disclosed to other organisations unless required by law.

H:\L2P Team 2015\FORMS\Mentor Application Form reviewed March 18th 2015.doc

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