COMPUTER CLUBHOUSE MENTOR
EXPRESSION OF INTEREST APPLICATION
The Computer Clubhouse is an after-school program at the Fitzroy Learning Network inc. We include young people ages 12 - 18
to develop their creative skills, confidence and develop both short and long-term projects in an informal and safe learning
environment, supported by a Coordinator and a team of Volunteer Mentors.
Volunteer mentors may have specific skills in the arts, sciences or in technology but this is not a requirement.
Primarily, the mentor's role is:
(a) to support all clubhouse members as they connect their interests with the skills they need to express those interests.
(b) to establish relationships with the students based on mutual respect and trust.
(c) to not only teach new skills, but to co-learn with students in a mutual quest for knowledge.
Mentors are guides, role models and active participants in the clubhouse, offering both encouragement and ideas. They are
facilitators of material and intellectual resources, lending skills in how to find information and use technology; they also
encourage innovative ways to engage with technology, aiming to encourage student resourcefulness and creativity.
Surname:
First Name:
Date of Birth:
Gender:
Address & Post Code:
Home Phone:
Mobile:
Email:
Country of Birth:
Other Languages:
How many hours per week would be able to mentor? (Clubhouse hours are weekdays, 3.30 – 6.30pm)
Briefly, what are your reasons for wanting to be a volunteer mentor?
Referees
Please provide three references with the names and contact phone numbers of one employer or supervisor referee; and
two character referees who are not family members (including partners). Email contact details are preferred.
Referee #1
Name:
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Phone (Home/Mobile):
Email:
Referee #2
Name:
Phone (Home/Mobile):
Email:
Referee #3
Name:
Phone (Home/Mobile):
Email:
Emergency Contact
Do you have any medical condition that we should know about? (Yes
/
No)
Please provide the names and contact number of two people we can contact in case of Emergency:
Name:
Phone (Home/Mobile):
Name:
Phone (Home/Mobile):
Please provide either of the following:
1) A copy of your Curriculum Vitae
and/or
2) A short biography (write this below)
Please write a short biography here: you can tell us about your qualifications, interests and the specific skills or
workshops you believe you could offer at the Computer Clubhouse:
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Personal Information
Fitzroy Learning Network needs to collect some personal information about our volunteers. This is used in the training and
placement process, as well as in the supervision of volunteers. Personal information is also collected to satisfy occupational
health and safety obligations and insurance requirements. This information will remain confidential.
I certify that the statements made in this volunteer application are true and correct, and have been given voluntarily. I
understand that the information may be disclosed to any party with legal and proper interest. I understand that I will not be
paid as a volunteer.
Applicants Signature
Date
Office Use Only
Application Received:
Volunteer interviewed:
Police Check number:
Date of issue:
WWC Check number:
Expiry date:
Reference checks completed:
YES / NO
Data added to Database:
AMES Training Start Date (Community Networkers):
Date Commenced volunteering:
Volunteer Position:
RECOMENDATIONS AND ADDITIONAL COMMENTS
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