Mentor Program Questionnaire Question Title * 1. Choose the title closest to yours. CEO COO VP Director Manager Intern Student Other Other (please specify) Question Title * 2. How many years of experience in healthcare leadership do you have? 1-5 years 5-10 years 10-15 years 15-20 years >20 years Question Title * 3. Have you ever participated in a Mentor program in the past? Yes No Question Title * 4. If yes with what organization? Question Title * 5. What was your experience? Question Title * 6. Would you be interested in participating in a Mentor program if GLACHE developed one? Yes No Maybe Question Title * 7. If yes what position would you be interested in? Mentor Protege Both Question Title * 8. Please provide contact info if interested. Done