1-On-1 Mentorship Application

1-On-1 Mentorship Application

application@mentoruuniversity.org
Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*
Family
Relationship Status*
If married, what is your spouses name?
Spouse's profession?
Any children? If so, what are their ages?*
Are your parents still alive?*
What is/was your relationship with your parents?*
Any siblings? If so, how many?*
Are you the older, younger, or middle child?
Briefly describe your childhood*
Religion/ Faith
Describe your faith/religion*
Do you have a church home/pastor, or a spiritual accountability partner?*
Do you know/understand your spiritual gifts?*
Professional History/Goals
What is your current profession? How long?*
Do you have any professional goals? What are they?*
If you could perform one job for the rest of your life, what would it be and why?*
Describe what you enjoy most about your current profession*
Describe the job/career where you were most fulfilled and why?*
Describe the job/career where you were least fulfilled, and why?*
Have you ever had significant disciplinary/performance issues at work? If yes, describe them.*
Education
What is the highest level of education you have received?*
Do you have any education goals?*
If you could go back to school, what would you major and minor in at this point in your life?*
Hobbies/Interests
What are your current hobbies, interests, activities?*
Are you physically active?*
What talents do you enjoy performing?*
Are you part of any clubs, associations, fraternities/sororities, groups, etc.*
Describe the perfect weekend*
Describe the perfect vacation*
Goals and Dreams
Describe what you would like to accomplish within the next 12 months?*
Describe what you would like to accomplish within the next 3 years?*
Describe what you would like to accomplish within the next 5 years?*
What is the legacy you would like to leave to your family?*
What is the legacy you would like to leave to your community?*
What is the legacy you would like to leave to the world?*
What are your spiritual development goals? (becoming a pastor, bible teacher, mentor, etc.)*
If you could pursue and succeed at one dream, what would it be? Why?*
If you could live anywhere in the world, where would it be? Why?*
Personal History/Goals
Have you had any legal issues (been sued, fined, etc.)?*
Have you ever been arrested? If so, when and what for? What was the outcome?*
Have you ever been a suspect or convicted of a crime? If so, when and what for? What was the outcome?*
Do you have any major health concerns?*
Have you ever been diagnosed with any mental health disorders?*
Are you currently under the supervision of a medical or mental health professional?*
Are you taking any prescription medications?*
Do you have any health goals?*
Accomplishments
What accomplishments are you most proud of and why?*
What do others compliment most about you?*
Which character traits are you most proud?*
What do you hope others would say about you behind your back?*
Should be Empty:

1-On-1 Mentorship Application

Family

Religion/ Faith

Professional History/Goals

Education

Hobbies/Interests

Goals and Dreams

Personal History/Goals

Accomplishments