Mentoring Questionnaire Your Name Your Email A mentor is: (pick the one that best describes your idea of a mentor) a) the best cheerleaderb) the smartest coachc) the kindest teacherd) the most creative guidee) the perfect role modelf) other (please explain) Do you have a practice in: a) meditationb) Chinese medicinec) a & bd) other (please explain) What is working in your practice right now? What’s not working? Why are you here? What kind of guidance/support are you seeking? Anything else I should know? Where do you see a mentoring relationship taking you? How long will that take? Which mentoring option are you interested in? a) 3 months - 6 meetingsb) 6 months - 10 meetingsc) 12 months - 20 meetings After I receive your application, I’ll be in touch to schedule a call so we can decide together if this is a good fit for both of us.