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TO LEAP Mentor EOI Form
Complete this Expression of Interest Form to Register as a mentor in the TO LEAP programs
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* Indicates required question
Email
*
Your email
Your full Name
*
Your answer
Your email address
*
Your answer
Your mobile number
*
Your answer
Your postcode
*
Your answer
Tell us a bit about work and educational background
*
Your answer
What is your experience in. starting a business or community project?
*
Your answer
What skills, knowledge or industry area would you like to share with the participants and other mentors in the program
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Your answer
I understand that attending an initial Information and induction workshop is a mandatory as part of joining the program.
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Yes
No
Which dates can you join an information and Induction workshop as well as 2 other training workshops
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Online
In Person
I can't attend any
Wed 8h May 5.30 - 8.30 pm
Mon13th May 5.30 -8.30 pm
Thur 16th May 5.30 - 8.30 pm
Thur 30th May 5.30 - 8.30 pm
Thur 16th June 5.30 - 8.30 pm
Online
In Person
I can't attend any
Wed 8h May 5.30 - 8.30 pm
Mon13th May 5.30 -8.30 pm
Thur 16th May 5.30 - 8.30 pm
Thur 30th May 5.30 - 8.30 pm
Thur 16th June 5.30 - 8.30 pm
Are you interested in attending 2 full days of mental health first aid training?
*
Yes
No
I already have a mental health first aid certificate
Other:
What days and times can you attend IN PERSON workshops
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Morning 10 - 1pm
Afternoon 4 - 7pm
Evening 5.30 - 8.30pm
I can't attend any on this day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Morning 10 - 1pm
Afternoon 4 - 7pm
Evening 5.30 - 8.30pm
I can't attend any on this day
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Where can you meet for workshops?
*
In North Melbourne or Flemington
In the city
Within the Inner city area
Online
Other:
Required
Are you a currently living or have you ever lived in public housing?
*
Yes
No
Have you ever applied or received grant funding for a business or community project?
*
I don’t know what grant funding is
I have not and do not know how to apply for a grant
I have applied for grant funding
I have received grant funding
I have successfully delivered a community project or business idea that was grant funded.
Other:
About me. I am a person who is:
17 years old or under
Between 18 - 35 years old
Between 36 - 50 years old
Between 51 - 65 years old
Over 66 years old
Migrant, Refugee or CALD background
Indigenous or Torres Strait heritage
LGBTIQ
A woman or identify as a woman
I am underemployed
I am unemployed
I am a part-time or casual worker
Living with a disability
Living with a mental illness
Have experienced domestic violence
With caring responsibilities
Other:
I understand that TO LEAP Lead is an 18 week program and i will need to attend 80% of the IN PERSON workshops
*
Yes
No
I AM ABLE TO mentor participants for 4 months from the Mon 15th July to November 2024
*
Yes
No
Other:
I AM ABLE TO attend:
- 3 training workshops in May and
- Meet the participants at a workshop on the 17th of June
*
Yes
No
Other:
How did you hear about this program
*
Your answer
Send me a copy of my responses.
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