The Premier's Lucy Mentoring Program - Application Form 2011

2. Your Details

* 1. Contact Details
Family Name:

Given Name:

Preferred Name:

Email:

Tel(H):

Mobile:

Postal Address:

.
* 2. Student Details

e
lin
Student Number:

on
Faculty:

Course / Degree Program:

n
Course Starting Date (e.g. Mar 2008):
y.

io
Expected Completion Date (e.g. Nov 2011):
nl
Current WAM:

at
O

Major:

ic
Minor (if applicable): pl
e

High School:
pl

ap
* 3. Required Information
m

Yes No
ur
Sa

I am an Australian citizen or permanent resident j

k
l
m
n j
k
l
m
n
yo

I am of Aboriginal or Torres Strait Islander origin j

k
l
m
n j
k
l
m
n
I have a credit average or above j
k
l
m
n j
k
l
m
n
e

I gained entry to UNSW through the ACCESS scheme j

k
l
m
n j
k
l
m
n
et

* 4. Please provide the full name you would like to put on your certificate. (check the
pl

spelling and punctuation carefully, your certificate will be printed exactly as you have
m

indicated)
co
se
ea
Pl

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The Premier's Lucy Mentoring Program - Application Form 2011
3. Meeting the Criteria

* 5. What motivates you to participate in the Lucy Program? Describe your ideal
mentor. (Maximum 150 words)
5

e .
lin
6

on
* 6. What are your career goals? Describe your potential to contribute to the public
and/or private sector. (Maximum 150 words)

n
y. 5

io
nl

at
O

ic
pl
e
pl

ap
m

ur
Sa

6
yo
e
et
pl
m
co
se
ea
Pl

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The Premier's Lucy Mentoring Program - Application Form 2011
4. Your Contributions and Skills

* 7. Describe and provide examples of your leadership qualities(Maximum 150 words)

5

e .
6

lin
8. [Optional question] Female students are invited to apply however priority will be

on
given to students who are experiencing or have experienced one or more form(s) of
disadvantage such as:

n
y.

io
• Disrupted schooling/education
nl

at
• Financial hardship
O

ic
• Family disruption/disrupted home environment pl
e

• English language difficulties

pl

ap
• Personal illness or disability
m

• Disadvantaged secondary school environment

ur
Sa

yo

If applicable, please provide details. (Maximum 150 words per category)

5
e
et
pl
m
co
se

6
ea
Pl

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The Premier's Lucy Mentoring Program - Application Form 2011
5. Preferences

* 9. We are offering a range of mentoring opportunities in 2011. Please indicate the

mentoring areas you are interested in.
1st Other Areas
Preference of Interest
(Pick One (Pick
Only) Multiple)
Accounting / Finance in Professional Services Firms c
d
e
f
g c
d
e
f
g
Banking c
d
e
f
g c
d
e
f
g
Consulting In Professional Services Firms c
d
e
f
g c
d
e
f
g

e .
Consulting: Property Consulting c
d
e
f
g c
d
e
f
g

lin
Education Management c
d
e
f
g c
d
e
f
g
c
d
e
f
g c
d
e
f
g

on
Engineering: Electrical, Mechanical & Mechatronic Engineering In Medical Technology

Engineering: Project Management c

d
e
f
g c
d
e
f
g
c
d
e
f
g c
d
e
f
g

n
Financial Planning & Investment Advisory
y.

io
HR / Learning & Development in Private Sector c
d
e
f
g c
d
e
f
g
nl

at
HR / Learning & Development in Public Sector c
d
e
f
g c
d
e
f
g
O

Public Relations c
d
e
f
g c
d
e
f
g
Journalism

ic c
d
e
f
g c
d
e
f
g
pl
e

c
d
e
f
g c
d
e
f
g
pl

Law & Banking

ap
c
d
e
f
g c
d
e
f
g
m

Law: Administrative / Public Law

Law: Barrister c
d
e
f
g c
d
e
f
g
ur
Sa

Law: Commercial & Property Law c

d
e
f
g c
d
e
f
g
yo

Law: Community Law / Social Justice c

d
e
f
g c
d
e
f
g
Law: Corporate Compliance c
d
e
f
g c
d
e
f
g
e

Law: Entertainment / Art Law c

d
e
f
g c
d
e
f
g
et

Law: Indigenous Law / Social Justice c

d
e
f
g c
d
e
f
g
pl

Law: Insurance Law c

d
e
f
g c
d
e
f
g
m

Law: Workplace Relations / Workers Compensation c

d
e
f
g c
d
e
f
g
co

Social Policy & Research c

d
e
f
g c
d
e
f
g

* 10. Please explain why you have chosen the above mentoring areas? (Maximum 150
se

words)
ea

5
Pl

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The Premier's Lucy Mentoring Program - Application Form 2011
6. Availabilities

* 11. If invited, are you available to attend a group

activity at the following time(s):
Yes No
Mon 16 May, 3-4pm j
k
l
m
n j
k
l
m
n
Mon 16 May, 4-5pm j
k
l
m
n j
k
l
m
n
Tue 17 May, 2-3pm j
k
l
m
n j
k
l
m
n
Tue 17 May, 3-4pm j
k
l
m
n j
k
l
m
n
Tue 17 May, 4-5pm j
k
l
m
n j
k
l
m
n

e.
* 12. Are you available at the following times to complete the Lucy

lin
Program:

on
Yes No
Student Briefing: Wed 22 Jun 3-4:30pm or Thurs 23 Jun 10-11:30am j
k
l
m
n j
k
l
m
n

n
The Launch: Tue 28 Jun, 4:30-6:30pm
y. j
k
l
m
n j
k
l
m
n

io
End of Program Function: Thurs 17 Nov, 4:30-6:30pm j
k
l
m
n j
k
l
m
n
nl

at
* 13. Please list your commitments for a typical week, including the type of activities
O

ic
and the hours of involvement. E.g. Monday: "Classes 9-11am, Student Society
pl
e

meeting 11-12, Work 1-3, Free from 3pm onwards".

pl

ap
m

List your commitments for Session 2, 2011 if you have confirmed your timetable.
ur
Sa

Otherwise please state your commitments in Session 1, 2011.

yo

Session 1 or 2:

Monday:
e

Tuesday:
et

Wednesday:
pl

Thursday:
m

Friday:
co
se
ea
Pl

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The Premier's Lucy Mentoring Program - Application Form 2011
7. Photographic Release
PHOTOGRAPHIC RELEASE

In order to be accepted into this program, you will need to agree to be photographed for promotional purposes.

I give the University of New South Wales, including its controlled entities and licensees, and the photographer, irrevocable rights to use
and re-use, publish and re-publish photographs taken of me on the dates below, in whole or in part, individually or in conjunction with
printed matter, or in composite form, and in any medium, for any promotional purpose of the University of New South Wales.

Session 1 / Launch : Tue 28th Jun, 4:30-6:30pm

End of Program Function: Mon 14th November 4:30-7pm

.
I waive my right to inspect or approve any advertising copy that is used in connection with the photograph for promotion of the

e
competition.

lin
* 14. I agree with the terms and conditions listed above.

on
j
k
l
m
n YES

j
k
l
m
n NO

n
y.

io
* 15. Name & Date.
nl

at
Name:
O

ic
Date (DD/MM/YYYY):
pl
e
pl

ap
m

ur
Sa

yo
e
et
pl
m
co
se
ea
Pl

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