PATH 4 LIFE | Mentor Program

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MENTOR APPLICATION FORM

Thank you for your interest in being a PATH 4 LIFE | Mentor.

Applications are now closed for 2023.

If you are still interested in applying to be trained in 2024, you can complete the application below. We will then keep you on our list and notify you with training dates.

A mentoring relationship is a 12-month commitment to build solid foundations.

Please complete all mandatory sections on this form.

All information you provide will remain private and confidential.

If you have any questions about the PATH 4 LIFE program please contact: Naomi Swart (PATH 4 LIFE, Mentor Program Liaison) - naomi@pathwaysmelbourne.org

Email *

First Name: *

Last Name: *

Date of Birth: *

YYYY

Mobile phone number *

Email address: *

Home address: *

Emergency contact name & mobile: *

Your relationship status: *

Married / De facto / Partnered

Separated / Divorced

Single

Do you have children? *

Yes

What’s your gender identity? *

Female

Male

Other:

Required

Do you identify as LGBTQIA+ *

Yes

Required

If you would like to expand on your gender/sexuality identity please do so here:

Do you have a Working With Children's Check card? *

Yes - I have a valid Working With Children's Check card

No - I am happy to apply for a Working With Children's Check card. This needs to be completed before the next training

Do you have a Police Check *

Yes - I have a valid Police Check

No - I am happy to apply for police Check. This needs to be completed before next training

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