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* 1. Name

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* 2. Email Address

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* 3. Phone Number

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* 4. Education: Please include degree and school

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* 5. Number of Years’ Experience

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* 6. Most current or recent title and organization

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* 7. What are you hoping to accomplish from the TRUST IMPACT Mentoring?

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* 8. Describe your strongest competencies (i.e. knowledge, skills and abilities).

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* 9. Describe competencies you would like to strengthen and/or leverage through working with a mentor.

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* 10. What are you looking for in a mentor?

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* 11. What are two important values you incorporate in your leadership style and why?

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* 12. What are five or six adjectives that best describe you? Please elaborate as much as possible.

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* 13. Describe qualities or personalities of people you find easy to work with? Difficult to work with?

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* 14. Describe your key areas of responsibility. which area offers the greatest challenge?

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* 15. What are your short and long-term goals?

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* 16. Please select the top 5 areas you would like to focus on with your mentor.

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* 17. What else would you like to add that will help us make the best possible match?

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* 18. Are there any competitive organizations we should avoid matching you with?

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* 19. Best describe the industries in which you have been employed or have significant experience.

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* 20. Are you able to commit at least 4 hours /month to this program?

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* 21. Please provide the geographical area in which you are willing to meet in person (e.g., South Metro)

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* 22. Have you been a mentor or mentee with the TRUST is in the past? Please explain when and why you are interested in the program again.

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* 23. Please be aware that due to the current situation this may be a virtual mentoring partnership. Do you still want to participate in the program.

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* 24. Please note that there is an investment of $300 to participate as a mentee that is due at the start of the program. Do you agree to these terms?

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* 25. Attach resume: Optional

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