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* 1. Contact Information

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* 2. What is your current job title?

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* 3. Briefly describe your path getting to your current job position.

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* 4. What is your functional area in the Plastics Industry?

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* 5. Would you prefer your mentor be from the same functional area as you?

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* 6. Have you ever been involved in a mentor/mentee program?

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* 7. What areas of focus would you like to learn more about?

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* 8. What are your future professional goals?

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* 9. What are some of your hobbies/interests outside of work?

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* 10. Reflect on a previous mentor: describe the mentor and how they impacted you.

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* 11. How do you expect this program to impact you and your job functions?

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* 12. Describe your ideal mentor and your preferred teaching style.

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* 14. Would you be willing to travel for this program? If so, how often?

  Never Once a year Twice a year Three times a year Quarterly More than Quarterly
Within a one-hour drive
Within a two-hour drive
Longer than a 2-hour drive
Flying

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* 15. When pairing you with a mentor, do you have a gender preference of who you would like to be mentored by?

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* 16. How would you prefer to communicate/meet with your mentor?

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* 17. When would you prefer to communicate/meet with your mentor?

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* 18. While meeting one time per quarter is required, more meetings can be scheduled based on the relationship and preference. How often would you want to meet with your mentor?

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* 19. Would there be any reasons you would stop the program at any point prior to the end of the mentor/mentee program?

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* 20. Do you have any other comments, questions, or concerns?

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