Mentor questionnaire

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MENTOR QUESTIONNAIRE

This questionnaire is designed so that mentees can verify the authenticity and qualifications of mentors.

Name:____________________________. Phone number(s): ___________________________________.

Email address _________________________________________________________________________.

Home Address: ________________________________________________________________________.

Employer: ____________________________________________________________________________.

Employer phone number and contact person: _______________________________________________.

Mentor category: ______________________________________________________________________.

Years experience in category: ______________. Description of exp. ______________________________

__________________________________________________________________________________.

Preferred method of contact for mentor sessions: Phone ___ Email ___ In person ___

Number of mentor sessions you are available for in the first year? ___.

Mentor session time allotted (example; 30 minutes on the phone)? _____________________________.

Reference 1: Name and contact info (email – Phone); ____________________________________________________________________________________.

Reference 2: Name and contact info (email – Phone); ____________________________________________________________________________________.

Resume attached?  Yes ___ No ___

What makes you a good mentor?

_____________________________________________________________________________________________________________________________.

Final Comments:

_______________________________________________________________________________________________________________________________.