Global Utilities

In2science Peer Mentoring Program

Registration

Please complete the following form and submit it to the In2science Team who will contact you shortly.

Personal Details
First Name:
please put a preferred name in brackets at the end if different: eg Joshua (Josh)
Family Name:
Gender
Semester address: number and street:
Suburb:
Post Code:
Phone:
Mobile:
University Email:
Own Transport?
Police Check
Do you have a current Working With Children Check?
If "Yes" enter Card No.:
University Details
University:
Campus:
Current Year level:
Degree:
Major(s):
Peer Mentoring Program Details
I am willing to mentor in the following subjects,
(remember that schools tend to teach General Science up to Year 10 - usually on a topic rotation):
Preferred Year Level to Mentor:
What school did you attend for VCE?:
Would you consider mentoring at your old school (if it is one of our partner schools)?:

What days are you available to mentor in 2010?
(Include the times you are free from and till)

(It does not matter if you do not know your availability now as this can be confirmed at a later stage):

Outline your reasons for applying to the In2science Program:
Please give details of the skills and qualities that you will bring to the role:
 

Content Approved by: Faculty Registrar
Page maintained by: Web Information Officer
Last Updated: 21 September, 2009