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Mentorship Pairing Questionnaire
Pursuing the best match for a mentor? Get it right with this form template !
11
Questions
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1
Name
First Name
Last Name
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2
Age
18-29
30-49
>50
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3
Education (check the highest degree achieved)
Diploma
Associates
Bachelors
Masters
Doctoral
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4
Do you have plans to continue your education?
BSN, BIT, MS, MBA, DNP, DM, DBA, PhD, etc.
Yes
No
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5
Are you intending to be a mentor or mentee?
Mentor
Mentee
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6
How would you describe your personality?
I keep to myself.
I talk to people sometimes.
I tend to talk to people often.
I am very outgoing.
I keep to myself.
I talk to people sometimes.
I tend to talk to people often.
I am very outgoing.
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7
What are your hobbies outside of work?
Select all that Apply
Cooking
Gardening
Outdoor Sports (hiking, kayaking, biking, skiing, hunting, fishing, camping, etc.)
Crafts (sewing, knitting, painting, scrapbooking, etc.)
Traveling
Technology Activities (computer gaming, video games, photography, etc.)
Other
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8
How would you describe your organizational preference?
Type A
Type B
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9
Are you a better texter or emailer?
Texter
Emailer
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10
How often do you want to be in contact with your mentor/mentee?
Twice a Week
Once a Week
Every other Week
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11
When you think about communicating with your mentor/mentee, how do you envision the relationship?
More casual – we will contact each other when we want to talk, knowing that the other person will be available for me when needed.
More structured – we will schedule phone calls, e-mails, or personal meetings to ensure we keep up with one another.
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