Name:_______________________________ Title:_______________________________
Department:__________________________ College:_____________________________
Campus Location: East Side West Side
Telephone:___________________________
Fax:__________________________________ E-Mail:_____________________________
Total years employed at UIC? ______________
Please rank the following ten items from 1 - 10 (using each numerical value only once) to indicate what you would be able to best provide for a mentee with 1 = best able and 10 = least able to.
_______ strategies for career advancement
_______ networking to increase exposure for potential career opportunities
_______ effective negotiation of political environment
_______ role modeling for position and academic culture
_______ provide professional support by being a sounding board
_______ developing interpersonal connections
_______ career path planning
_______ assist in the identification of blind alleys and stumbling blocks to advancement
_______ helping mentees' to better articulate and realize their dreams
_______ providing constructive feedback and skill building
Would you be interested in participating in training programs aimed at supporting and developing the mentors? Yes No
Check the time(s) that you would be available for training?
8:00-9:00am 9:00-10:00am 12:00-1:00pm 4:00-5:00pm 5:00-6:00pm
Check what day(s) would be best for training?
Monday Tuesday Wednesday Thursday Friday
As a Mentor would you attend training sessions in the following areas:
Active Listening Skills: Cornerstone of the Mentoring Relationship
Yes No
How to Give Effective Feedback Yes No
Communication and Team Building Across Personality Styles Yes
No
Other Suggested Topic Areas: ___________________________________________________
Signature: _______________________________ Date:_______________________
Return completed forms to by May 15, 1999
Rebecca Gordon
Office of Women's Affairs (MC 363)
Phone: 413-1025 Fax: 413-8393
rebeccag@uic.edu
Name:_________________________________ Title:_______________________________
Department:____________________________ College:_____________________________
Campus Location: East Side West Side
Telephone:___________________________
Fax:__________________________________ E-Mail:_____________________________
Total years employed at UIC? ______________
Are you a faculty menber interested in moving into administration? Yes No
Please rank the following ten items from 1 - 10 (using each numerical value only once) to indicate what is most important for you to receive from your mentor with 1 = most important and 10 = least important.
_______ learning strategies for career advancement
_______ networking to increase exposure for potential career opportunities
_______ effective negotiation of political environment
_______ role modeling for position and academic culture
_______ professional support by being a sounding board
_______ developing interpersonal connections
_______ obtain constructive feedback and skill building
Briefly describe your career goals? ___________________________________
__________________________________________________________________________
__________________________________________________________________________
Would you be interested in participating in training programs aimed at supporting and developing the mentees? Yes No
Check the time(s) that you would be available for training?
8:00-9:00am 9:00-10:00am 12:00-1:00pm 4:00-5:00pm 5:00-6:00pm
Check what day(s) would be best for training?
Monday Tuesday Wednesday Thursday Friday
Would you attend training sessions in the following areas:
Making Mentoring Work for You
Yes No
Career Exploration Yes No
Communication Across Personality Styles
Yes No
Other Suggested Topic Areas: ___________________________________________________
Signature: ______________________________ Date:_______________________
Return completed forms to by May 15, 1999
Rebecca Gordon
Office of Women's Affairs (MC 363)
Phone: 413-1025 Fax: 413-8393
rebeccag@uic.edu