All Stars for Autism Telethon Teen Mentoring ProgramMentor - Expression of Interest To be written by the Mentor with support as required. Applicant's Full Name * Person applying to become a mentor First Name Last Name Applicant's Date of Birth * The mentor position is open to autistic students in year 10, 11 or 12 Applicant's Phone Number (if they have one) Applicant's Email (if they have one) Parent/Carer Name * First Name Last Name Parent/Carer Phone Number * Parent/Carer Email * What do you (applicant) hope to gain from the group? * Have you had any kind of leadership role within a school environment? If yes, please describe what this role entailed. * Have you volunteered for a company or organisation? If yes, please describe what this role entailed. * Have you been involved in a sporting or community group? What was the nature of this group and what did you like about it? Were there any challenges you encountered and if so, how did you overcome them? * Are you able to participate with minimal support in a group setting? Yes No Unsure Are you able to follow complex verbal instructions? * Example - You will be able to follow cooking demonstrations and, with some visual and oral support from a support worker, replicate recipes independently. Yes No Unsure With the support of an adult, are you able to communicate and teach complex verbal instructions to other children? * Example - You will be able to follow cooking demonstrations and, with some visual and oral support from a support worker, show others how to replicate recipes and provide support to Mentees. Yes No Unsure Are you able to attend to a task with minimal support? * Yes No Unsure Are you able to regulate your emotions and work cooperatively with others in a small group dynamic? If not, how can we help best support you? * Do you behave in a safe manner towards others in a group setting? * Yes No Unsure Can you commit to attending weekly sessions (Thursday Afternoons) including team building and training sessions? * Yes No Unsure What are some of your interests, talents and skills you would like to explore and expand upon in the sessions? * Describe your strengths and talents and why you think you would make a good mentor to younger autistic children. * Are you from an Aboriginal and / or Torres Strait Islander background? * Yes No Prefer not to say Are you from a Culturally and Linguistically Diverse background? Yes No Prefer not to say Photo/Media Release Consent * All Stars for Autism may take photographs and video footage of you carrying out your work 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 image on social media platforms. Do you agree with this? (Optional) Yes No Application Video/Letter * Along with this application, please submit a short video or letter explaining why you would make a great mentor. Videos should be 1-2 minutes long, and letters should be around two paragraphs. Send your submission to hello@allstarsforautism.org.au with your name in the subject line. Video Letter Do you have any allergies or dietary requirements? * Do you have any additional medical conditions? If yes, please provide details. * Thank you for applying for the mentor position in the Telethon Teen Mentoring Program! We will be in touch soon.
