Mentee Questionnaire

From (name):
Email address (required):
Organization (optional):
Address:

City:
State:
Zip:
Phone (optional):
Fax (optional):

What do you hope to gain from a mentoring relationship?

What particular help are you seeking (e.g., particular methodology, general guidance, show consulting, etc.)?

Who do you envision as a mentor (e.g., someone with similar background--education, culture, gender--or different, a peer with different expertise, a seasoned practitioner)?

Have you ever been mentored? If yes, what is the one element that stands out about that relationship? If no, what is the one thing you wish you had had from a mentor?