First Name

Last Name



Date of Birth:

Cultural Background:

Do you fluently speak any languages other than English? 

If yes, what language/s?

Do you hold a current drivers licence? 

Do you have access to a vehicle? 

Current employment status: 

Do you have any circumstances that may impact your ability to act as a mentor? 

If yes, please specify:

I am a Australian citizen or permanent resident: 

Please list any previous volunteering you have done: 

How did you hear about WJN’s Mentoring Program? 

Other, please state: 

Why are you interested in becoming a mentor with WJN?: 

What personal qualities or life experience can you bring to WJN’s Mentoring Project?: 

Do you have any connections, either personal or professional, with the criminal justice system?: 

If yes, please provide details. Please note, answering yes to will not affect your eligibility to become a WJN mentor: 

Are you willing to enter into and sign a Mentoring Agreement? 

Are you willing to abide by a Mentoring Code of Conduct? 

Can you commit to 12-month participation in WJN’s Mentoring Program? 

Do you agree to participate in 2-day training? 

Do you agree to attend on-going training and supervision every 6-weeks? 

Please supply email contacts for two character references: 

Your mentee, Kate, is an Aboriginal woman in her 40s. She has recently been released from custody for alcohol related theft and assault. Kate wants to get her life back on track but is feeling overwhelmed and doesn’t think anyone understands her. She is unable to see any of her four children and reports feeling depressed. Kate admits she has started drinking again and is scared she will end up back in custody. As Kate’s mentor how do you think you could best support her? 


Please note a confirmation email will be sent to the listed email address.

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