Protégé Questionnaire

Please respond to each of the questions below for our 2024 Mentorship Program. Thank you for taking the time to complete it.

First Name:	Click or tap here to enter text.

Last Name:	Click or tap here to enter text.

Email:	Click or tap here to enter text.

Cell Phone #:	Click or tap here to enter text.

LinkedIn Profile:	Click or tap here to enter text.

Current Role:	Click or tap here to enter text.

Current Employer:	Click or tap here to enter text.

**Please submit a digital photo with your completed questionnaire

Q1: How many years of experience do you have in the talent and development industry?

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Q2: The following are the dates of our mandatory Mentorship Program events. Check any that you cannot attend.

Mentor Program Information Session (Optional): Wednesday, January 10 (6pm – 7pm) ☐

Protégés Program Information Session (Optional): Thursday, January 11 (6pm – 7pm) ☐

Mandatory Orientation Webinars: Wednesday, January 17 (6pm – 7pm) ☐
or Saturday, January 20 (10am – 11am) ☐

Kick-off Pairing Event: Saturday, February 3 (9:00am – 12:00pm) ☐

Mid-term Event: Saturday, April 13 (10am – 12pm) ☐

Graduation Event: Saturday, June 22 (10am – 12pm) ☐

Q3: Which of the following best describes your participation in the Carol Susan DeVaney Mentorship Program? Check all that apply.

I am new to the Mentorship Program

I have been a protégé in the past

I have been a mentor in the past

Q4: Rate your expertise in each area below using the 1-4 rating scale provided.
1 is a very strong competency, 4 is a weak competency.

Instructional Design (classroom/instructor led)	Choose an item.

Instructional Design (eLearning)	Choose an item.

Facilitation (classroom)	Choose an item.

Facilitation (virtual)	Choose an item.

Leading/Managing Learning (Talent Development)	Choose an item.

Measuring and Evaluating training	Choose an item.

Coaching	Choose an item.

Consulting	Choose an item.

Change Management	Choose an item.

Leadership Development	Choose an item.

Q5: Please list any certifications you have earned.

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Q6: What would you like a potential mentor to know about you?

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Q7: What are your top two goals/main objectives of being a protégé in the program?

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