Learner Driver Mentor Program - Expression of Interest

Please fill out the form below to express your interest in joining as a participant in our Learner Driver Mentor Program. If you need assistance with obtaining road safety skills and supervised driving hours in pursuit of your Provisional (P1) Licence or Open Licence we would love to support you in that.

This form is to only be completed by residents of Toowoomba, Queensland.

Our team will contact you to discuss how to proceed once we have been provided with the below information and as program capacity allows. Please monitor your emails as you may need to provide further information before being accepted into the program.

Apply Here

First Name *

Last Name *

Email *

Phone *

Date of Birth *

What suburb do you live in? *

What is your age in years? *

What is your gender? *

Are you of Aboriginal or Torres Strait Islander origin? *

What languages do you speak? * Please also note your English ability here. EG: English learner, no English etc.

Are you a licence holder? *
Please also note your English ability here. EG: English learner, no English etc.

Yes, I have an International Licence Yes, I have an Australian Learner Licence No

On what date did you earn your licence? *

How many driving hours have you already completed? *

Do you have someone in your life who would be able to help you learn to drive, but may not have the resources? * Yes No

Do you have any preferences about who your mentor driver is? *
EG: If you need to be paired with a female driver please say so here. Please be aware that we will do our best to accomodate these preferences, but it can impact the amount of time spent on the waiting list.

Please note any additional information you would like us to know below *
If you are applying on someone else's behalf please say so here.

HP: