ACADI Mentor Application
Thank you for your interest in the ACADI Mentoring Program. 

Our goal is to facilitate the sharing of skills, knowledge, career and leadership guidance to support PhDs and EMCRs working in the field of diabetes.

Key dates:

Facilitated Online Mentor Training by Serendis Leadership: Thursday 09 May 2-4pm  AEST
Celebratory event to finish the program: Thursday 14 November 2024

Optional: Midpoint Checkin at the Australasian Diabetes Congress 21-23 August 2024  

Please complete the application form below - the answers will be used to assist us in matching mentors with mentees.
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Name *
Title, First and last name
Email *
Phone number *
Gender *
Assistant email  (if applicable)   
Please select the state or territory you work in. *
Networking and building relationships with other participants *
Do you give permission for ACADI to share your name, organisation, role and email address (as it appears in this application) with others in the mentoring program?
Professional details  *
Which organisation is your primary workplace? If you are affiliated with more than one organisation, please select your primary place of work from the list below and add additional organisations in the next question. 
Please list organisations with which you are affiliated: *
Please describe your current role and responsibilities *
Max. 400 characters. 
If you are actively involved with research, please provide an overview of your current research interests.  Alternatively, you can provide a link to your online bio or an ORCID ID instead. *
Max 550 characters. 
Please provide a succinct bio *
Alternatively, you can provide a link to your online bio or an ORCID ID instead.
Program goals *
Your mentee is likely to have a specific goal/s for the program. Which of these mentee goals do you believe you will be most effective in supporting? 
Required
From the list below, please select your key competencies and areas of strength where you can support your mentee.  *
Please select all that apply. 
Required
Would you prefer to be matched with a mentee of a specific gender? If so, please state the gender below.  *

An integral element of the program’s success is NOT matching mentors and mentees where there may be a potential conflict of interest or limited professional overlap. Are there any disciplines you would prefer to AVOID being matched with? Are there any organisations in which your mentee should NOT work?

 *
Is there any further information you want to share with us relevant to your participation in the program. This may include potential conflicts or personal considerations not already captured.      *
Program details *
Attending the initial facilitated online training session, online one-on-one sessions with your mentee and the in-person event in Melbourne on 14 November will be critical to the success of this program. We know how busy career and life can be, and the program is structured to support you through these challenges. Attendance to the sessions ensures the program is a valuable investment of your time. If this is not the right time for your or if this sounds like something you cannot commit to, please let us know. Please note, travel and accommodation will be paid for for Celebratory event to finish the program.

The dates for training are: 
Facilitated Online Mentor Training by Serendis Leadership: Thursday 09 May 2-4pm  AEST
Celebratory event to finish the program: Thursday 14 November 2024

Optional: Midpoint Checkin at the Australasian Diabetes Congress 21-23 August 2024  

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