Professional Development
at the University of Waikato
M
E N T O R I N G
S
C H E M E
A
P P L I C A T I O N
F
O R M
PER SO NA L D E TA IL S
Name:
Position:
Department:
Year of Appointment:
Phone Extension:
Email:
Gender:
F/M
M EN T OR I N G PR E F ER E NC E S
1. Please tick the appropriate box (one only) to indicate which role you are seeking in a
mentoring partnership.
 Mentoring
 Being mentored
2. Would you prefer to work with a colleague:
 Inside your unit or department
 Outside your unit or department
 Don’t mind
3. Would you prefer to be paired with a:
 Female
 Male
 Either
4. Please indicate the areas below in which you are either interested in providing (as a mentor)
or for which you are seeking guidance.








Career path guidance and support
Research and publication guidance and support
Getting to know your work environment
Guidance and support with teaching related matters
Familiarisation with administration and structure at all levels
Developing professional capability
Leadership role
Other: ___________________________________________
5. What are your educational qualifications?
__________________________________________________________________________
__________________________________________________________________________
Teaching Development Unit & Professional & Organisational Development Unit
6. Please provide any further information you feel is relevant
7. If you have previously been involved in a formal mentoring arrangement please provide a
brief description (i.e. where, how long, what were the benefits/limitations?)
F UR T H ER IN F OR M A TI O N
Thank you for expressing an interest in the University of Waikato Mentoring Scheme. Once we have
received all applications we will endeavour to match partners for effective mentoring relationships. We
will contact you in due course to discuss this further with you. In the event that we are unable to pair
you with a suitable partner we will retain your details on a waiting list as we will regularly be
advertising this scheme.
The Teaching Development Unit will contact you to arrange a briefing session prior to your first
meeting.
_________________________________________________________________________________
Please forward your completed form to:
Mike Bell
Professional & Organisational Development Unit (POD)
Email: [email protected] Extension: 8894
Teaching Development Unit & Human Resource Management Division Professional Development