Online Registration

To register, please fill out our online form below. You will receive a tax invoice via email once you press 'Send'.

Details of active youth mentoring program will be published on the VYMA website. Please ensure we are aware of any changes to these details. By submitting this form you authorise VYMA staff to share your contact details with our stakeholders including referring agencies and other parties interested in youth mentoring.

To ensure VYMA advocacy and support activities reflect your needs. Please also fill out the brief questionnaire component of this form. (This information is for internal VYMA use only.)

We will do our best to get back to you within three working days of RECEIVING YOUR PAYMENT.

Name of Program:

Name of Organisation:

Aim of Program:

Nominated Person:

Position:

Email Address:

Street Address:

Suburb:

Postcode:

Phone:

Mobile:

Website:

What would best describe your target group?

 

At risk school attendees

 

Unemployed

 

Indigenous

 

Disability

 

Refugees

 

Gender specific - males

 

Gender specific - females

 

Faith or culture oriented

 

Youth justice

 

Child protection

Age of Target Group:

Number of young people:

Number of mentors:

Program Model:

If other please specify:

Program Setting:

If other please specify:

Location of Program: 

Melbourne Metropolitan

 

Northern Metropolitan

 

Western Metropolitan

 

Eastern Metropolitan

 

Southern Metropolitan

 

Victoria Wide

 

Barwon-South Western

 

Gippsland

 

Grampians

 

Hume

 

Loddon Mallee

 

Please Note: Information collected below is strictly confidential and will only be used for advocacy and program support.

When did your program commence?:

 

How many hours of initial training do you provide mentors before they are matched?:

 

What is the average length of a mentoring relationship in your program?:

 

What best describes the role of the mentor in your program?

 

Other role:

 

Approximately how many young people have you been unable to match in the last 12 months due to a lack of space in your program?

 

What sort of system (if any) do you use to evaluate the effectiveness and impact of your program?

 

Who developed the system above?

 

Name three key organisations you partner with:

Organisation 1:

Organisation 2:

Organisation 3:

 

What do they bring to the partnership? (eg Referral of young people, mentors, financial support, in kind support

Organisation 1:

Organisation 2:

Organisation 3:

 

How much is your program's operating budget (including wages), per annum?

 

What percentage of your funding comes from the following:

Federal Government (funding %)

State Government (funding %)

Local government (funding %)

Other NFPs (funding %)

Business/ corporations (funding %)

Individual donations (funding %)

Trust and foundations (funding %)

Other (please specify)

 

Please name your major funding source?

What date did this funding commence?

What date does this funding cease?

What is your program's biggest challenge right now?

 

Is there any additional support the VYMA could be providing you?

Member Type:

Organisational Member - $55.00

(Income to youth mentoring program/s across the organisation under $25,000)

Organisational Member - $150.00

(Income to youth mentoring program/s across the organisation under $150,000)

Organisational Member - $250.00

(Income to youth mentoring program/s across the organisation under $1 million)

Supporter Membership - $250.00

(If you would like to stay connected and support the VYMA, but are not running a youth mentoring program.)

Individual Member - $22.00

(If your organisation is already a member)

Method of Payment:

Payment through EFT

VYMA Account Details:
Account: Victorian Youth Mentoring Alliance
Bank: Bendigo Bank BSB: 633 000 Acc: 127 731 990

Cheque

Send your confirmation email/ tax invoice with a cheque to:
Victorian Youth Mentoring Alliance
PO Box 21241
Little Lonsdale St
Melbourne VIC 8011

I wish to become a Member of the Victorian Youth Mentoring Alliance and agree to be bound by the Rules of the Association.