Protégé 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. Program of participation *

  12. Year of participation *

Current Status

  1. Are you currently a student? *

  2. If yes, where are you studying
  3. Field of study

  4. Are you currently employed? *

  5. If yes, where are you employed
  6. Position/Title

  7. Are you volunteering? *

  8. If yes, where are you volunteering
  9. Type of volunteer work

  10. Gender *
    If other, please specify

  11. Language *
    If other, please specify

  12. Please outline your professional objectives: *

  13. Please indicate the field(s) of practice in which you are interested in working (ex. environment, health, education, marketing, community development, law, etc.):

Please indicate your level of motivation for seeking a mentor:

  1. To develop my social and professional network

  2. To gain a better understanding of the field I want to work in (i.e. principal employers, organization of the industry, upcoming trends and forecasts, particularities of the industry, etc.)

  3. To develop leadership skills and strategies to be more effective in the workplace and my community

  4. Improve my technical skills and professional expertise

  5. Improve teamwork and team building capacities

  6. To learn about the needs of employers and develop a better understanding of recruitment trends in the field I wish to work in

  7. To enhance my communication skills

  8. To get professional guidance 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 you expect being in a mentorship relationship will impact your professional development. *

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 *

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