Mentor Form

April 8, 2016 Dwayne

Name*
First Last
Email*
Age*
School*
Subject Area wants to Mentor*
Age group wants to Mentor*
1. Why do you want to become a mentor?*
2. What are some ways you can establish rapport (communication) with the students you are mentoring?*
3. Please briefly describe any mentoring experience you have had.*
4. List four adjectives to describe yourself
5. How would these qualities affect your work as a mentor?*
6. What might interfere with your success as a mentor?*
7. Have you had any mentoring experience before (positive/negative)?
8. We mentor persons of all abilities …can you work equally well with persons of all abilities? Please explain.*
9. Why would you be a good mentor?*
10. What do you think are major difficulties persons experience in your specialty area?*
11. How would you approach working with an unprepared person?*
12. What specific advice would you give on succeeding?*
13. How would you build a person's confidence?*
Give the names and telephone numbers of two persons who can testify your credentials*

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