Mentor Application Assessment In order for us to better fit you with the appropriate Protégé, please provide the following information: Your Name* First Last Email* PhoneHave you ever been in a Protégé/Mentor relationship/program?NoYes, but it was an informal relationshipYes, but it was in a formal program:What was the name of the program?If you have been in a Protégé/Mentor relatio nship/program in the past, what did you find valuable? What wasn’t valuable about the relationship/program?What do you plan to achieve as a result of this program? Please include professional, academic, personal, leadership, extracurricular, and any other goals you plan to accomplish via this program.Do you want to be matched with someone within the security industry?Yes, I would like to be matched with a Protégé from my field of security.No, I would like to be matched with someone from a different field of securityI do not care if the Protégé is in my field or in a different field of security.What is your primary area of expertise within the security industry?What other areas within the security indus try would you feel comfortable providing mentoring and guidance.What is your educational level? You may select more than one, if applicable. High School 2-year College 4-year College/University Certification(s) PhD Graduate level degree Other Education What is your highest professional experience? Entry Level Manager (1-10 employees, one program) Vice President, Senior V.P., Executive V.P. Mid-Level Manager (1-10 employees, one program) President Advanced Level Manager (1-10 employees, one program) CEO/COO Program Manager CSO, Corporate Director Director, Senior Director, Executive Director Consultant Other: Select all areas below you would feel comfortable proving mentoring assistance with to a Protégé? On-going career development Networking Used to solve a long-term project Area specialty development and practice Skill improvement Guidance on job searches Company/Industry cultural comprehension Resume critiques Educational foundation expansion Mock interviews Broader quality performance Informational interviews Enhance/Increase professional visibility Project collaboration and/or critique Practice strategies Other: What mechanisms of communication do you have available to you to interact with your Protégé? Supply information on those you wish to use. Business Phone: Cell Phone: Business e-mail: Personal e-mail: Go-to-meeting capabilities: Live chat: Video conferencing: Face-to-face meetings: Other: Business Phone:Cell Phone:Business e-mail:Personal e-mail:Go-to-meeting capabilities:Live chat:Video conferencing:Face-to-face meetings:OtherAre you willing to provide both verbal and written feedback to the Protégé and/or the Protégé’s manager (if the Protégé requests manager’s inclusion into the program)?Yes, I am willing to provide both verbal and written feedback to the Protégé.I am willing to provide only verbal feedback to the Protégé.I am willing to provide only written feedback to the Protégé.I am willing to provide verbal and written feedback to the Protégé’s manager, if requested by the Protégé.I am willing to provide only verbal feedback to the Protégé’s manager, if requested by the Protégé.I am willing to provide only written feedback to the Protégé’s manager, if requested by the Protégé.No, I am not willing to provide feedback to the Protégé’s manager. I wish to work with the Protégé exclusively.CAPTCHANameThis field is for validation purposes and should be left unchanged.
