register YOUR INTEREST

Inspire Change

MENTOR APPLICATION FORM
Student ID
FAN
Name

First NameLast Name
Gender

Other
Do you identify as Aboriginal or Torres Strait Islander?
Date of birth (DD-MM-YYYY)

DayMonthYear
Date
University Email
example@flinders.edu.au
Mobile number

Area CodePhone Number
Residential Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cultural Identity
Languages spoken
Name of Degree/Course you are currently studying
Pathway to University
High School Attended
Do you hold a current DCSI Working with Children Check? (If not we can start this process for you)
Do you hold a current Responding to Risk Harm and Neglect Certificate? (If not we can send through the link on how to do this)
In 200 words or less, please tell us a little bit about yourself and why you want to be a mentor?
Where did you hear about us?
Emergency contact
Name of contact
Relationship to contact
Mobile number

Area CodePhone Number
We will contact you to arrange an interview time. If you have any questions or concerns that require addressing before the interview, please email inspire@flinders.edu.au.
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Inspire Change