All Stars for Autism Telethon Teen Mentoring ProgramMentee - Expression of Interest Applicant's Name * Person applying to become a mentee First Name Last Name Applicant's Date of Birth * The mentee position is open to autistic students in year 6 & 7 Applicant's Gender Parent/Carer Name * First Name Last Name Email * Phone Number * What does your child hope to gain from the group? * Is your child able to participate with minimal support in a group setting? * Yes No Unsure Is your child able to follow complex verbal instructions? * Example - Your child will be able to follow cooking demonstrations and, with some visual and oral support from a Mentor and Support Worker, replicate recipes independently. Yes No Unsure Is your child able to attend to a task with minimal support? * Yes No Unsure Is your child able to regulate their emotions and work cooperatively with others in a small group dynamic? If not, how can we help best support your child? * Does your child behave in a safe manner towards others in a group setting? * Yes No Unsure What are some interests, talents and skills your child would like to explore and expand upon in the sessions? * Is your child from an Aboriginal and / or Torres Strait Islander background? Yes No Prefer not to say Is your child from a Culturally and Linguistically Diverse background? Yes No Prefer not to say Photo/Media Release Consent * From time to time, we will capture photo and/or video content to share on our social media channels and promotional material. You agree that All Stars for Autism Incorporated may take photographs and video footage of your child/your children undertaking activities and use it for the purposes of marketing and promotion of All Stars for Autism Incorporated and its goods or services. This may include printed and digital marketing, including the use of your child/your children image on social media platforms. Yes No Does your child have any additional medical conditions? If yes, please provide details. * Does your child have any allergies or dietary requirements? * Thank you for applying for the mentee position in the Telethon Teen Mentoring Program! We will be in touch soon.
