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Alumni Mentoring Survey

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www.viscardicenter.org > Alumni Mentoring Survey

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Name(Required)

First Last

Phone(Required)

Email(Required)

Are you currently employed?

Yes

No

If yes, please note your current employer, title, and a brief description of your role and or tasks.

Are you currently attending college or a vocational program?

Yes

No

If yes, note where, the major/focus and your intended graduation date.

When would you like to begin mentoring?

Please indicate how much time you would be able to commit to a mentee:

A session a week

A session a month

Would you be interested in mentoring?

An individual

A small group of individuals

Which times and days work best for you?

Monday

Early morning

Morning

Afternoon

Evening

Tuesday

Early morning

Morning

Afternoon

Evening

Wednesday

Early morning

Morning

Afternoon

Evening

Thursday

Early morning

Morning

Afternoon

Evening

Friday

Early morning

Morning

Afternoon

Evening

Weekend

Early morning

Morning

Afternoon

Evening

What is your preferred method/methods of communication? [Please check all that apply]

Email

Phone

Text

Video call

In-person

Which areas do you feel you are best suited to provide guidance on? [Please check all that apply]

Accessible transportation

Adaptive sports options

Advocacy

College-related topics, i.e., applying to college, transitioning to college, campus disability services, asking for accommodations, socializing on campus, etc.

Disability benefits

Employment-related topics, i.e., resume development, applying for/interviewing for a job, asking for accommodations, disclosing a disability, interacting with co-workers, etc.

Equipment/Assistive technology

Financial literacy, i.e., balancing a checkbook, opening a bank account, etc.

Health, i.e., medical referrals/specialists, insurance, etc.

Hiring/Directing personal care assistants

Social/recreational activities/entertainment

Travel, i.e., accessible accommodations

Other

What are your desired outcomes of becoming a mentor? [Please check all that apply]

Increase my involvement with Viscardi and its alumni

Develop additional leadership skills

Impart knowledge and expertise

Gain a personal sense of satisfaction from knowing I have helped someone

Act as a role model

Do you commit to keeping regular appointments with your mentee and providing 24-hours’ notice should you need to reschedule?

Yes

No

Do you commit to being prepared for each mentee meeting, as appropriate?

Yes

No

Is there anything else you would like to share?

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The Viscardi Center

National Business & Disability Council at The Viscardi Center

201 I.U. Willets Road

Albertson, NY 11507

516.465.1400

info@viscardicenter.org

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