This information is used solely for the BWiC Build Her Mentor Program.

Only AGC MA will have access to this information.

Your responses will be kept private and secure.

The information will not be used for a discriminatory purpose.

You can change this information in the future by resubmitting the survey.

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* 1.  Name

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* 2. Industry Experience: (years in the industry, titles, certifications, association experiences, personal accomplishments)

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* 3. Would you prefer one on one or group mentoring?

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* 4. What are the skills you want to develop?

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* 5. What resources are currently available to you to help you move forward?

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* 6. Do you have any role models you look up to or people you admire?

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* 7. What’s a challenge you’re currently facing in your career?

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* 8. What’s the next risk you want to take in your career? What’s holding you back?

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* 9. What ideas have you developed to help you overcome challenges and meet your goals?

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* 10. What was a period in your life or career where you felt like you had the most growth?

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* 11. What interested you about having a mentor?

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* 12. Is there a preference on who you get matched with in terms of gender identification, sexual orientation, race, or any other demographic? (We will do our best to accommodate.)

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