Your Name (required) Your Organisation Role(s) – indicate primary role: How long in your primary role? Office Location Your Email (required) Level of Role (Pick closest) Senior ManagerExecutiveCEODirectorBoard Chair If a Chair/Director nominate: ASX20ASX200ASX500Other Please provide a bio: What do you hope to achieve by participating in the mentoring program? (max 300 words): What do you believe you can personally contribute to the mentoring program? (max 300 words): What specific development needs can you offer support in a mentoring relationship? Better understanding of strategic directionDevelopment of Leadership Skills such as ... (clarify below)Development of other professional skills such as ... (clarify below)A person who can act as a ‘sounding board’ sharing experience in:Developing work life balancing strategiesInfluencingImproving self awareness and self confidenceIncreasing contacts and networkingAnything else? Expand on above if required... In your opinion, what are the critical success factors that will make a mentor / mentee relationship succeed or fail? (Max 300 words) Please outline how you have developed people before? Please include development methods you have applied and in particular any previous experience of mentoring (when, areas of focus, your role, etc). (max 300 words) Do you have any preferences or requirements you would like the Mentoring Committee to take in to account? This may include preferences for specific people or characteristics – positive or negative. This information is confidential and only used to assist the matching process. (150 words) Are you able to commit to attending a monthly meeting with your mentee (1 to 1.5 hours) through June to October (inc) 2019? YesNo Is there any area that you would like further development/coaching/support in to enhance your mentoring experience: (max 300 words) I am willing to work with: One MenteeTwo Mentees Anything else you would like us to know about you? Any concerns? Note: People accepted into the Verity Mentoring Program in 2019 receive free Verity Leadership subscription (valued at $99, with discounts available across Verity Leadership workshops and other events). Please see our website for details on Verity Leadership Events.