Mentor Questionnaire

The purpose of this questionnaire is to provide the Mentor Project with a more detailed profile of you and your interests.  This profile, along with your application and interview, are used by Mentor Project staff to best match you with a student.  All elements of your profile are kept in the strictest of confidence.  Thank you for taking the time to complete this questionnaire.

Name ___________________________________________

Education ________________________________________ Other education _______________________ ______________________________________________________________________________________

Work history (please include a brief description of responsibilities):

Title/Description/Date ___________________________________________________________________ ______________________________________________________________________________________

Title/Description/Date ___________________________________________________________________ ______________________________________________________________________________________

Title/Description/Date ___________________________________________________________________ ______________________________________________________________________________________

Have you ever worked with young people before?  If so, please describe: ___________________________ ______________________________________________________________________________________

If you have participated in a mentoring program before, what agency, city, state, and when?____________ ______________________________________________________________________________________

What job skills can you share with a youth? __________________________________________________ ______________________________________________________________________________________

What hobbies can you share with a youth? ___________________________________________________ ______________________________________________________________________________________

Can you commit to spending a minimum of 4-6 hours per month for one year with a student? _________

Do you anticipate any changes in the next year that may interfere with your ability to meet your commitment as a mentor such as marriage, childbirth, new job, moving?  If yes, please explain:                                                        ______________________________________________________________________________________ ______________________________________________________________________________________

Are you bilingual?  If so, what languages? ____________________________________________________

Please provide any additional information that you feel would help us match you with a youth:                                                          __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please fax or mail back to Natalie Parkos, Project Assistant at:

Students In Business, Inc.
4588 Peralta Blvd., Ste. 17
Fremont, CA 94536
Fax: (510) 795-6498
Phone: (510) 795-6488 x 6185
Email: nparkos@beamentor.org