Mentoring Program Mentee Form

Please tell us about you. We use this information you share with us to help match you with a mentor.

Name

First NameLast Name

Email

example@example.com

Your gender

Your ethnicity

Do you have a disability?

YesNoPrefer not to say

Current role

Current position level (e.g. senior advisor, principal, graduate)

Is this a people leader or manager role?

YesNo

Your organisation

Contact phone number

Why do you want to join the programme as a mentee?

What do you want to achieve from participating in the programme?

What do you see as the benefits to your career from participating in the programme?

In which specific areas of your career development would you like support from a mentor? (select all that apply)

Applying economics to your work (e.g. for those with no/little economics background)Strengthen leadership capabilitiesImprove interpersonal and communication skillsCareer planning and progressionBuild confidenceBalancing culture/community/careerDevelop professional practiceIncrease networking opportunitiesOther

If you selected other, please specify

Of the specific areas above that you identified for mentor support, please tell us the top three areas, in order of priority

What are your career goals and aspirations?

What other career development are you currently doing? (Include formal and informal development.)

Having a mentor the same gender as me is important

YesNoNo preference

If you have a disability, are there accommodations that we, or your mentor, may need to make for you to fully participate in the programme? If yes, please tell us what they are.

Do you have support from your manager? Please ask your manager to tell us specifically how they will support you in this programme (i.e. managing workload, helping you identify opportunities to progress your career)

I commit to meeting with my mentor once a month

YesNo

I commit to being prepared to attend these meetings

YesNo

I commit to seeking opportunities to practice or apply knowledge and skills I gain

YesNo

I commit to attend the mentor/mentee group workshops (4x workshops x2 hours each)

YesNo

Signature

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Date

Please complete this form and email it to nzgenconnect@gmail.com by 14 April 2023.