MENTORING PARTNERSHIP PROGRAM QUESTIONNAIRE
MENTORING PARTNERSHIP PROGRAM QUESTIONNAIRE
Name_______________________________________ Designation(s) _______________ Date_________
Address ___________________________________________ City ______________________________
State______ Zip _____________
Phone: Home _____________________ Work _________________Ext______ Cell _________________
Email: Work _________________________________ Home ____________________________________
Employer ____________________________________________________ Years in Industry __________
Job Title/Description ____________________________________________________________________
Career Goal(s) ________________________________________________________________________
_________________________________________________________________________
Interests/Hobbies ______________________________________________________________________
Local Association ____________________________________________________ Year Joined ________
IAIP Goal(s) _________________________________________________________________________
_________________________________________________________________________
Are you looking for a mentor or a mentee? ______________________________
Ever been a Mentee before? __________ If 'Yes", was it a positive experience? ___________________
Why? _______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Ever been a Mentor before? __________ If 'Yes", was it a positive experience? ___________________
Why? _______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Preferred Mentor/Mentee communication methods ranked 1 to 4 with 1 being the highest:
Face-to-Face ______
Email _____
Phone _____
Skype _____
Preferred day of the week for communications:
First Choice ___________________ Second Choice ________________ Third Choice ______________
Preferred time of day for communications:
First Choice ___________________ Second Choice ________________ Third Choice ______________
Preferred communications frequency ranked 1 to 4 with 1 being the highest:
Monthly _____
Bi Monthly _____
Weekly _____
Other _____ Description _______________________________________________________________
Comments: _________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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