Mentor Questionnaire

Name*

First Last

Date*

MM

DD

YYYY

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone

How would you prefer to communicate?*

What’s your current job function?*

What is your current stress level?*

How are you managing your stress?*

What are your greatest strengths?*

What’s the #1 thing you would like to get out of your mentorship?*

Where would you like to grow your area of expertise?*

If you had to describe yourself:*

Examples: sports nut, techie, social butterfly, dog lover, foodie, health nut, traveller etc.

What would you like to accomplish regarding your goals short term (1-6 months)?*

What would you like to accomplish regarding your goals short term (6 months-1 year)?*

What are your top passions?*

What are a couple of the major challenges you are experiencing and trying to overcome in your life at the moment?*

What does mentorship mean to you?*

Describe your ideal mentor:*

Is there anything else you would like to share?