How old are you?

Thank you for your interest in becoming a Burgmann Alumni & Friends (BAM) Mentor.
Please complete the form below.
You are welcome to email bam@burgmann.anu.edu.au if you have any questions or concerns.

Mentor Details

Full name: *Please include preferred title.

Email: *We prefer your ongoing email address where possible to avoid losing contact.

Phone *

Field for mentoring (1): *

Field for mentoring (2): *

Professional field: *

Current employer: *

Current position: *

Location: *

Brief professional biography: *

Please upload your CV (not compulsory):

Are you happy to have your portrait photograph published on the Burgmann College website? *

Yes, I will upload a portrait photograph via this form (please see below)Yes, I will email a portrait photograph to bam@burgmann.anu.edu.auNo thanks, I would prefer not to provide a photograph

Please upload a portrait photograph (optional)

Please indicate your years at College and/or describe your connection to the College: *

THANK YOU
We look forward to being in touch and pairing you with a resident mentee.
Please email bam@burgmann.anu.edu.au with any queries or comments.

Declaration and Authority to Use Information

By submitting this form:

• I understand that my information will be handled in line with the Burgmann College Privacy Policy which is found on this website under Policies.

BAM Mentor Form

Mentor Details