Carlmont Academy Mentor Survey
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1. Default Section
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1
. Type in your First Name
Type in your First Name
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2
. Type in your Last Name
Type in your Last Name
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3
. Select your gender
Select your gender
Male
Female
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4
. Please type in your occupation
Please type in your occupation
5
. Please type in your employer's name
Please type in your employer's name
6
. Please type in any previous occupation you may have had
Please type in any previous occupation you may have had
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7
. Please type in any hobbies or interests you have
Please type in any hobbies or interests you have
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8
. Please type in an e-mail where we may contact you
Please type in an e-mail where we may contact you
9
. Please type in your business phone number, including
any extensions
Please type in your business phone number, including any extensions
10
. Please type in a home phone number
Please type in a home phone number
11
. Please type in a cell phone number
Please type in a cell phone number
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12
. Please select the best way to contact you
Please select the best way to contact you
E-mail
Home phone
Cell phone
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13
. Would you be willing or able to take a student with you
to work for a job shadow?
Would you be willing or able to take a student with you to work for a job shadow?
Yes
No
Not sure
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14
. Please indicate if you have been a mentor before, and if
so, where?
Please indicate if you have been a mentor before, and if so, where?
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15
. Is there anything in your background that would
prevent you from becoming a mentor?
Is there anything in your background that would prevent you from becoming a mentor?
Yes
No
16
. Please explain what you would like to "get" from the
experience of being a mentor. What expectations do you
have?
Please explain what you would like to "get" from the experience of being a mentor. What expectations do you have?
17
. Please type in any other comments or important information
you would like to share
Please type in any other comments or important information you would like to share
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18
. I testify that these answers are truthful by typing
in my name below.
I testify that these answers are truthful by typing in my name below.
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