NAWLEE Mentoring Questionaire Survey

The NAWLEE Mentoring Program is voluntary for NAWLEE members in good standing. If you elect to participate, you agree to the rules, policies and criteria of the program. It is your responsibility to seek any clarification of the rules, policies and critiera from the program coordinator.

1. Please enter the following demographic information:

Please enter the following demographic information: Name:
Rank:
Company:
Address:
City/Town:
State/Province:
ZIP/Postal Code:
Country:
Email Address:
Phone Number:

2. I am interested in participating in the mentoring program as:

I am interested in participating in the mentoring program as: Mentor

Protege

Both (Protege and Mentor)

3. List the work that you performed, jobs held, or other work related experience that may give us insight into your skills,knowledge or interests. (ex: agencies, positions held, military etc.)

List the work that you performed, jobs held, or other work related experience that may give us insight into your skills,knowledge or interests. (ex: agencies, positions held, military etc.)

4. Education (Name of institution(s), degree(s), emphasis area):

Education (Name of institution(s), degree(s), emphasis area):

5. Please check any specialized skills you may have:

Please check any specialized skills you may have: Field Training Officer K-9 Patrol Investigations Traffic Unit DARE Defensive Tactics Instructor Bike Patrol Drug Unit	Academy Instructor Grants SWAT/Tactical Crime Scene Investigator Juvenile Officer Staff/Support Services Dispatch Accreditation Assessment Center	Sexual Assault Unit EVOC Recruiting Policy Events Planning Emergency Managemnt Internal Affairs Homeland Security Mentoring
Other (please specify)

6. Please list any volunteer work you are or have been involved in:

Please list any volunteer work you are or have been involved in:

7. What is the size of your agency?

What is the size of your agency? 1 - 49

50 - 99

100 - 249

250 - 499

500 - 999

1,000 +

8. Please check any hobbies or special interests:

Please check any hobbies or special interests: Bowling Golf Fishing Hiking Softball Running Working Out Gardening	Home Projects Quilting Cooking Reading Biking Movies Horses Family Time	Travel Football Motorcycle Dancing Tennis Basketball Music Theater/Arts
Other (please specify)

9. Please check three (3) words to describe you:

Please check three (3) words to describe you: Honest Articulate Outgoing Dependable Driven Fair Intellectual Open-minded	Enthusiastic Approachable Professional Reserved Assertive Loyal Trustworthy Workaholic	Dedicated Good Humor Good Communicator Goal Orientated Knowledgeable Listener Hardworking Ethical
Other (please specify)

10. Please check three (3) words to describe a mentor you would like:

Please check three (3) words to describe a mentor you would like: Honest Articulate Outgoing Dependable Driven Fair Intellectual Open-minded	Enthusiastic Approachable Professional Reserved Assertive Loyal Trustworthy Workaholic	Dedicated Good Humor Good Communicator Goal Orientated Knowledgeable Listener Hardworking Ethical
Other (please specify)

11. Please check three (3) words to describe a protege you would like:

Please check three (3) words to describe a protege you would like: Honest Articulate Outgoing Dependable Driven Fair Intellectual Open-minded	Enthusiastic Approachable Professional Reserved Assertive Loyal Trustworthy Workaholic	Dedicated Good Humor Good Communicator Goal Orientated Knowledgeable Listener Hardworking Ethical
Other (please specify)

12. Please provide family background (number/order of siblings and any other comments on family you would like to make):

Please provide family background (number/order of siblings and any other comments on family you would like to make):

13. List prior cities/states/countries you have lived in:

List prior cities/states/countries you have lived in:

14. Please list any other interesting things (likes/dislikes, values, etc):

Please list any other interesting things (likes/dislikes, values, etc):

15. Please provide a brief synopsis of your long term goals:

Please provide a brief synopsis of your long term goals:

16. Please provide a brief synopsis of your short term goals:

Please provide a brief synopsis of your short term goals:

17. I agree to participate in the NAWLEE Mentoring Program and agree that my participation is voluntary. By checking below, I agree to abide the the program rules, policy and criteria of the program. Upon receipt of your questionaire you will recevie an email confirmation from the program coordinator.

I agree to participate in the NAWLEE Mentoring Program and agree that my participation is voluntary. By checking below, I agree to abide the the program rules, policy and criteria of the program. Upon receipt of your questionaire you will recevie an email confirmation from the program coordinator. I agree