Mentor Questionnaire

If you have problems filling in this form or if you have questions, please contact:

Mathieu Dagonas
Head of Philanthropy
mdagonas@cwy-jcm.org
1-800-605-3526 x 600


  1. First Name *

  2. Last Name *

  3. Street Address *

  4. Address Line 2

  5. City *

  6. Province *

  7. Postal Code *

  8. Phone *

  9. Fax

  10. Email *

  11. Have you ever been involved with CWY in the past? If yes, please specify how and when. *

Current Status

  1. Place of Employment *

  2. Professional Title / Position *

  3. Years of experience in the professional position/field *

  4. Gender *
    If other, please specify:

  5. Language *
    If other, please specify:

  6. Please provide a brief description of your position and responsibilities *

  7. Please indicate the field(s) of practice in which you work or have previous experience (ex. environment, health, education, marketing, community development, law, etc.)

Please indicate your level of capacity in the following areas:

  1. I have a good professional network

  2. I know my industry and sector well (i.e. principal employers, organization of the industry, upcoming trends and forecasts, particularities of the industry, etc.)

  3. I am recognized for my leadership skills in the workplace and community

  4. I am recognized for my technical skills and professional expertise

  5. I have strong teamwork and team building capacities

  6. I am aware of the needs of employers and can guide a candidate to develop an employable profile

  7. I have well developed communication skills

  8. I have a good understanding of my field and can provide my protégé with the guidance and connections to develop a strong career plan

  9. What is your experience in a mentorship relationship? *
  10. Please describe why you chose to participate in this program and how your qualifications and expertise will contribute to your success as a mentor. *

Other comments

If you would like to let us know about any other information about your application, please let us know below.

CV *

We ask that all mentors and protégés include a copy of their current CV with their application to provide to their mentorship partners and to aid CWY in creating the best possible mentorship match. Please upload your .doc, .docx or .pdf file.

Agreement *

Cet article est également disponible en FR.