Complete this form if you would like to be a mentor. All fields are required.

Name

Surname

ID / Passport number

Date of Birth

Cell phone number

Email Address

Street Address

City

Province Province *Eastern CapeFree StateGautengKwaZulu-NatalLimpopoMpumalangaNorth WestNorthern CapeWestern Cape

ZIP / Postal Code

Country Country *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo Democratic RepCosta RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland RepublicIsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussian FederationRwandaSt Kitts NevisSt LuciaSaint Vincent the GrenadinesSamoaSan MarinoSao Tome PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

Names and phone numbers of two people we can contact in case of emergency *

How did you hear about 18twenty8®?

Please tell us more about your background, personal, academic and professional aspirations

Have you ever been a mentor or participated in mentor training? Have you ever been a mentor or participated in mentor training? Yes No

Please tell us more about your mentor experience

Have you ever been arrested or convicted of a crime? Have you ever been arrested or convicted of a crime? Yes No

Please give us more information

Information on interests (Please select all applicable options) Information on interests (Please select all applicable options) Sports Movies Music Arts and Culture Religion / Faith / Spirituality Other

Other Interests

Interaction Level Interaction Level Our Little Sisters require varying levels of interaction with their Big Sisters. In order to accurately and realistically assess your availability, please take transportation time, your lifestyle, family, social, academic and work obligations into consideration when answering the following question. I anticipate being able to meet my Little Sister Once a quarter Once every 2 months Once a month Once a fortnight Once a week Daily

Please provide details on the preferred university, degree programme and geographic area of Little Sister

What would your 28 year-old self say to your 18 year-old self?

Additional Support Additional Support In addition to being a Big Sister, I would also like to (please select all applicable options): Financially sponsor student(s) undergraduate education costs Assist with organisational fundraising for 18twenty8® Present at Big Sister Network events Grow the Big Sister Network

What expectations do you have about your Little Sister?

Upload Profile Photo Upload Profile PhotoFile InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, gif, png, bmp, txt, asc, c, cc, h, srt, csv, rtf, pdf, zip, doc, pot, pps, ppt, docx, docm, dotx, dotm, pptx, pptm. Max. file size: 20 MB

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Upload Certified ID Upload Certified IDFile InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, gif, png, bmp, txt, asc, c, cc, h, srt, csv, rtf, pdf, zip, doc, pot, pps, ppt, docx, docm, dotx, dotm, pptx, pptm. Max. file size: 20 MB

Upload Qualifications Upload QualificationsFile InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, gif, png, bmp, txt, asc, c, cc, h, srt, csv, rtf, pdf, zip, doc, pot, pps, ppt, docx, docm, dotx, dotm, pptx, pptm. Max. file size: 20 MB

I confirm that I can commit to being a Big Sister for no less than 12 months from the date of submission of this form I confirm that I can commit to being a Big Sister for no less than 12 months from the date of submission of this form Yes

I have read, understand and accept the confidentiality statement. I have read, understand and accept the confidentiality statement. Confidentiality statement