Mentor Application Form

Academic Background
Qualification/s and Training (please list them below with year and institution): *

0/300
What specializations do you have *

General Information

Please note: in line with Make a Difference Leadership Foundation's Child Protection Policy, we require that criminal checks are conducted for all volunteers.
Have you ever been convicted of a crime? *

Yes No
Do you object to a criminal check? *

No Yes
If yes, please provide a reason:

Background Experience and Interests

Please provide us with the following information in order to find the right mentee for you
What experience do you have working with young people? *
What do you like to do in your leisure time? *
Please indicate your preferences, if any, to the following:
Grade level of your Mentee: *
Gender of your Mentee: *
How many mentees would you be willing to mentor? *
General comments that you feel may be important for us to know?
Our programme allows for the amount of time you can commit to your mentee. It also provides for both personal and professional mentoring. Please note that you can do both types of mentoring, however please do indicate the type you would predominantly prefer to participate in.
How often would you like to have contact with your mentee? *

Once per month Bimonthly Quarterly
While the following options overlap as a mentor, which would you predominantly prefer? *

Mentor in a professional/ career capacity. Mentor in a personal capacity assisting your mentee to navigate personal life situations
Where did you hear about Make A Difference Leadership Foundation's Mentorship Programme? *

References

Please provide us with at least two contactable. No more than one family member.
Reference 1
Name: *

First Name Last Name
Contact Number: *
Email: *
example@example.com
For how long and in what capacity do you know this person?
Reference 2
Name: *

First Name Last Name
Contact Number: *
Email: *
example@example.com
For how long and in what capacity do you know this person? *
Should be Empty:

Connect: Mentor Programme