Job Shadowing Mentor Interest Survey Question Title * 1. Contact Information Name Company Company Address Job Title Email Race Sex Question Title * 2. On a scale of 1-10, how interested are you in having a student job shadow you for one day each month in March, April and May? Not Really Interested Somewhat Interested Very Interested Interest Level Interest Level Not Really Interested Interest Level Interest Level Somewhat Interested Interest Level Interest Level Very Interested Question Title * 3. Would you be willing to commit to 2-3 hours for each month during a work day? (Specific dates to follow) Yes No Question Title * 4. What aspects of your job do you think will be valuable to share with student interested in this particular career path? Question Title * 5. If one day each month for March, April and May does not work for you, would you be willing to commit to ONE job shadowing day sometime during the spring? Yes No Question Title * 6. Please list any other friends, members of your family, or other coworkers that may be interested in this job shadowing program (Please also include their email) Question Title * 7. Do you have any experience working with young people? If so, in what capacity? Question Title * 8. Any additional comments or questions? Done