Online Survey Software | Qualtrics Survey Solutions

Please answer the questions that appear below.

Your answers will assist the committee in pairing you with a mentee.

First Name:

Last Name:

Preferred Pronouns:

(Optional) Please provide the URL for your LinkedIn page:

(Optional) Please attach a copy of your resume.

Title:

UCR Email Address:

Please enter how many years you have worked in your current position:

Please provide a basic description of your work experience:

Would you be willing to mentor two mentees?

Yes
No

Would you be willing to conduct mentorship activities remotely?

Yes
No

Please list strengths/skills that you would be able to share with a mentee:

This section is especially useful when making your match so please provide as much information as possible.

What characteristics, skills or experiences are you looking for in a mentee?
This section is especially useful when making your match so please provide as much information as possible.

If selected for the program, in what ways do you hope the mentorship program will contribute to your career/UCR experience?
This section is especially useful when making your match so please provide as much information as possible.

Please note the time you would be able to allot to the program, using the scale below:
We understand that availability fluctuates throughout the year -- a best guess will suffice. Please also indicate times of day you're likely to be available (ie: mornings, noon, afternoons, outside of work).

Please note the time you would be able to allot to the program, using the scale below:
We understand that availability fluctuates throughout the year -- a best guess will suffice. Please also indicate times of day you're likely to be available (ie: mornings, noon, afternoons, outside of work).
	Mornings (8-12)	Lunch (12-1)	Afternoons (1-5pm)	After Hours (5pm and beyond)
Mondays	Mornings (8-12)	Lunch (12-1)	Afternoons (1-5pm)	After Hours (5pm and beyond)
Tuesdays	Mornings (8-12)	Lunch (12-1)	Afternoons (1-5pm)	After Hours (5pm and beyond)
Wednesdays	Mornings (8-12)	Lunch (12-1)	Afternoons (1-5pm)	After Hours (5pm and beyond)
Thursdays	Mornings (8-12)	Lunch (12-1)	Afternoons (1-5pm)	After Hours (5pm and beyond)
Fridays	Mornings (8-12)	Lunch (12-1)	Afternoons (1-5pm)	After Hours (5pm and beyond)
Saturdays	Mornings (8-12)	Lunch (12-1)	Afternoons (1-5pm)	After Hours (5pm and beyond)
Sundays	Mornings (8-12)	Lunch (12-1)	Afternoons (1-5pm)	After Hours (5pm and beyond)

Please note how many hours per month you would be willing to commit towards serving as a mentor:

Please check events that you would be comfortable participating in with your mentee:

Phone calls

Answering emails

Meeting during meals

"Shadowing" for mentees

Meetings

Please share any comments that will help us pair you with the best mentee possible.
Use this space to describe any other aspects of yourself not already covered above, e.g. hobbies, interests, volunteer work, or anything else about yourself that will help facilitate the matching process.