ASIS Boston - Mentor Application Assessment

* First Name

* Last Name

* Email

* Have you ever been in a Protégé/Mentor relationship/program?

No
Yes, but it was an informal relationship
Yes, but it was in a formal program

* If you have been in a Protégé/Mentor relationship/program in the past, what did you find valuable? What wasn’t valuable about the relationship/program?

* What do you plan to achieve as a result of this program? Please include professional, academic, personal, leadership, extracurricular, and any other goals you plan to accomplish via this program.

* Do you want to be matched with someone within your field of security?

Yes, I would like to be matched with a Protégé from my field of security
No, I would like to be matched with someone from a different field of security
I do not care if the Protégé is in my field or in a different field of security

* What is your primary area of expertise within the security industry?

* What other areas within the security industry would you feel comfortable providing mentoring and guidance.

* Would you be willing to mentor for specific certification domains? You may select more than one, if applicable.

CPP
PSP
PCI
APP

* Topics you would be willing to mentor.

* What is your highest professional experience?

Entry Level Manager (1-10 employees, one program)
Mid-Level Manager (10-20 employees, several programs)
Advanced Level Manager (20+ employees, multiple programs & sites)
Program Manager
Director, Senior Director, Executive Director
Vice President, Senior V.P., Executive V.P.
President
CEO / COO
CSO, Corporate Director Consultant

Other

Select all areas below you would feel comfortable proving mentoring assistance with to a Protégé?

Other

* What mechanisms of communication do you have available to you to interact with your Protégé? Supply information on those you wish to use.

Business Phone
Cell Phone
Business e-mail
Personal e-mail
Go-to-meeting capabilities
Live chat
Video conferencing
Face-to-face meetings

Other

* Are you willing to provide both verbal and written feedback to the Protégé and/or the Protégé’s manager (if the Protégé requests manager’s inclusion into the program)?

Yes, I am willing to provide both verbal and written feedback to the Protégé.
I am willing to provide only verbal feedback to the Protégé.
I am willing provide only written feedback to the Protégé.
I am willing to provide verbal and written feedback to the Protégé manager, if requested by the Protégé.
I am willing to provide only verbal feedback to the Protégé manager, if requested by the Protégé.
I am willing to provide only written feedback to the Protégé manager, if requested by the Protégé.
No, I am not willing to provide feedback to the Protégé manager. I wish to work with the Protégé exclusively

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