Mentees:

Name:

E-mail:

Contact Number:

Age:

High School/University -

Course (if applicable):

Youth organisation (if applicable):

Are you currently authorised to work in Australia:

If not an Australian citizen, what is your country of origin?:

Are you an Indigenous Australian/Torres Strait Islander?:

What area(s) are you interested in: TICK BOXES (MAY SELECT MORE THAN ONE):

What publication(s) would you be interested in working on? (MAY SELECT MORE THAN ONE):

What days are you available to commit to The Colosoul Group Inc.? TICK BOXES (MAY SELECT MORE THAN ONE):

Do you want to part of the mentorship program?:

How long are you willing to commit for: (TICK BOXES – SELECT ONE ONLY):

Why do you want to participate in the mentorship program?: