Mentor Leaders Program Expression of Interest

Thank you for your interest in the In2science Mentor Leaders Program. This program wouldn't be possible without you, as a valuable STEM Professional, providing insight and guidance to the next generation of STEM professionals. For further information, please email In2science Program Manager Nicky at n.butler@latrobe.edu.au.

Title

(e.g. Mr, Ms, Mrs, Dr)

First name

Last name

Your pronouns

(e.g. they/them, she/her, he/him)

Preferred email address

(e.g. example@example.com)

Please upload a photo of yourself

Attach file

Drop files here

Current affiliation or place of employment

(e.g. La Trobe University)

Current role/position

I identify as:

We use this information, where possible, to arrange a meaningful, relevant placement. This information will not be shared with any third parties without your express permission. Select all that apply.

Tell us a bit about yourself!

You may wish to include information about your personal hobbies, passions, cultural background, etc.

{name}

Tell us about your career path.

Previous jobs, titles, roles, etc.

{name}

Please list your qualifications or degrees.

e.g. Bachelor of Science, Certificate II in Business

{name}

Please describe in 1-2 sentences what you feel you have to offer to mentees.

You may wish to talk about your strengths or personal achievements.

{name}

Which of the following disciplines would you be comfortable mentoring in?

If you answered 'other' above, please specify disciplines:

Please select the areas you would be happy to provide mentorship in:

If you answered 'other' above, in what area(s) could you provide mentoring?

Do you prefer your mentor meetings to be:

If you selected 'other' above, please specify how you would like to meet with your mentee:

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