Name:
Address:
Phone:
Cell:
Personal Email:
Work Email:
Employer:

1. How long have you been a Central Florida ASTD Member?
2. How many years have you worked in the learning/performance improvement industry?
 
3. Select 1-2 competencies that you would like your mentor to be currently utilizing in his/her career.
 
4. Which is most important to you when looking for a mentor – rank in order of importance:
(1 being most important - 4 least important)
Mentor is currently utilizing the above selected skills/competency in his/her career
Mentor has at least 5 years of experience in my desired skill area
Mentor may not be currently utilizing the skill/competency, but has over the course of his/her Career
Mentor has a passion for the skill/competency however may not utilize it in his/her career
 
5. List any additional, specific skills and/or experience you are looking for in a Mentor:
 
6. Why did you choose learning/performance improvement as a career?
 
7. Briefly describe your current position and/or work/school experience:
8. List three objectives you’d like to accomplish through the Mentor/Protégé program:
1.
2.
3.
 
9. List three strengths you will bring to the mentoring relationship:
1.
2.
3.
 
10. Please provide any additional information you feel may be helpful when matching you to your mentor..
 
11. Are you able to attend the below listed key events and provide time for communication with your protégé between meetings?
Yes    No

Meeting Requirements

  • Kick-off/Matching Event –TBD
  • Progress/Check in Event –TBD
  • Progress/Check in Event –TBD
  • Graduation Event –TBD
   

* Please direct all inquiries regarding the Mentor/Protégé Program to mentoring@astd-cf.org