AUSIT Mentoring Program - Mentee Referee Form

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T2 2021

Your name (first name and last name) *

E.g. John Smith

Your email *

What is your current position? *

E.g. Senior lecturer/Constable/Teacher/Freelancer, etc.

What is your current employer? *

E.g. The University of New South Wales/Queensland Police/Toowong Primary School/Self-employed, etc.

Are you an AUSIT member? *

Yes

Are you a program coordinator/staff member of AUSIT affiliate? *

Yes

What is your AUSIT member number?

What's the mentee's name? *

E.g. John Smith

How many years have you known this mentee? *

This referee form is submitted by *

Please insert your full name below.

By submitting this form, I declare that, to my best knowledge, the aforementioned mentee is of good character and suitable as a mentee for the AUSIT Mentoring Program. *

Yes, I do declare.

Submit

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