Mentors/Mentees Nomination Form & Matching Questionnaire
Thank you for your interest in participating in the WICT Greater Ohio Mentoring Program!
This questionnaire has been prepared to help us get to know more about you as a potential mentor, but will also help us match you with an appropriate mentee. Please use the section at the end “Anything else we should know?” if there is anything important we haven’t covered in the questionnaire. Alsonote that information provided here may be used in the participant packet for the 2015 program.
Return the completed questionnaire to Jeannette Richardson @ y Monday, June 30.
Personal Details
Name:
Email:
Contact Phone Number (business hours):
Professional Experience
Current Place of Employment:
Current Job Title:
Mentors/Mentees Nomination Form & Matching Questionnaire
Professional Experience –Provide a brief overview of your current and past work experience as well as your areas of expertise.
Professional Interests-List 3 to 4 areas of interest (e.g., social planning, development assessment, policy guidelines)
Mentoring
Have you previously been involved as a mentor or mentee in a mentoring program?
□ Yes – (please circle) Mentor or Mentee – Program Name (optional)
□ No
Are you able to commit the necessary time (meet with mentee at least once monthly) to the mentoring program?
□ Yes
□ No
What motivated you to want to be a mentor or mentee?
What do you want to achieve from participating in the mentoring program? (List top 3 things)
What do you believe that you can offer to a mentor or mentee in the program?
What do you consider to be important qualities in a potential mentor or mentee?
What are your personal interests and hobbies outside of work?
Anything else you would like to tell us or think would be helpfulin the matching process? (i.e.. preference in mentee’s location, professional interests, etc.)
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