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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