Mentoring Program - MENTEE APPLICATION FORM

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  • ACHSM Mentoring Program – MENTEE APPLICATION

  • Part A: Personal details




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  • Part B: Professional details

  • Part C: Your objectives from participating in the Mentoring Program

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    • PART D: EXPERIENCE AND EXPERTISE SUMMARY




















    • MENTOR COMMITMENT TO THE MENTORING PROGRAM

    • Mentee Responsibilities Statement

      1.    To be a financial member of ACHSM for the membership year;
      2.    To complete the ACHSM Management Competency Assessment;
      3.    To accept responsibility for my own decisions and actions; 
      4.    To ensure absolute confidentiality of matters discussed and information supplied by the Mentor;
      5.    To discuss and seek prior approval with my Mentor if I would like to nominate them as a referee:
      6.    To work with my Mentor to identify objectives from participation in the Mentoring Program and collaboratively develop a plan designed to address
              these  objectives;
      7.    To maintain regular contact with my Mentor (face to face meetings at least every 2 months if practicable);
      8.    To keep a record of management experience obtained during the period so that full discussion can be undertaken with my Mentor;
      9.    To initiate meetings and make regular contact with my Mentor;
      10.   To carry out tasks and projects by agreed times; 
      11.   To review performance and progress with my Mentor;
      12.   To promptly respond to requests for information from the Mentoring Coordinators and informing them of any changes in my contact details;
      13.   To participate in the evaluation of the Mentoring Program; and
      14.   To attend the Orientation session (this will be organised by your mentoring coordinator in each state).