Mentoring Needs Questionnaire
Your Name
First Name
Last Name
Your Hobbies and Interests
Visual Arts
Electronic Games
Film Travel
Music
Volunteering
Politics
Reading (Fantasy/Fiction)
Sports
Literary Works
Other
What Best Describes you
Outgoing
Business-oriented
Constructive
Empathetic
Funny
Lively
Intuitive
Passionate
Reserved
Reflective
Vibrant
Other
Have you had mentoring before?
Yes
No
Areas where you hope your mentor to make impact
Knowledge and practice of youth work or related professions
Personal Development (strengths, weaknesses)
Skills Improvement (e.g. communication)
Career guidance
Life skills (e.g. cooking, local habits, travelling)
Other
The role you would like your Mentor would take part
Listener
Teacher
Motivator
Career Development
Life Coach
Other
Your Preference of Communication with your Mentor
email
chat
text
phone
personal
Other
Your Preferred Mentor
Male
Female
Where do you hope to be in five years?
What do you hope to gain from this relationship?
Are there any ground rules you would like to set (e.g., confidentiality, openness, candor)?
Are any topics off limits?
What do you think will be challenging about this relationship?
What criteria would you like to use to evaluate the success of the relationship?
Any additional remarks or questions from your side
Submit
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