SHP Faculty Scholarly Development - Survey for Mentors

Faculty Scholarly Development Site
Last name    Last name should NOT be empty First name    First name should NOT be empty

1. In which of the following areas do you feel qualified to provide mentorship?

Classroom Instruction
Online Instruction
Professional Development Education (Training)
Research
Scholarly Writing
Grant Writing
Grant Management
Administration
Financial Management
Organizational Change
Advancement in the Academic Environment
Faculty Governance
Program Accreditation
New Program Development - Academic
New Program Development - Research
New Program Development - Service Community Based
New Program Development Other
Other

2. Of the areas of mentorship described above please indicate the three areas you feel most qualified to provide mentorship. (Select three)

Classroom Instruction
Online Instruction
Professional Development Education (Training)
Research
Scholarly Writing
Grant Writing
Grant Management
Administration
Financial Management
Organizational Change
Advancement in the Academic Environment
Faculty Governance
Program Accreditation
New Program Development - Academic
New Program Development - Research
New Program Development - Service Community Based
New Program Development Other
Other

3. Please select up to three of the following that best represent the skills/abilities that you would bring to a mentoring relationship (Select three)

Active Listening
Support and Facilitate Networking and Brokering
Teach by Example
Be Aware of Potential Role Conflict
Encourage and Motivate Protege to Move Beyond Comfort Zone
Promote Independence
Promote Work-Life Balance
Convey Positive Feedback and Enthusiasm for Protege's Success
Encourage Reciprocity and CollaborationNULL
Provide Constructive Feedback
Other

4. Please select up to three of the following that best represent the skills/abilities/qualities that you would want a protege to bring to a mentoring relationship (Select three))

Taking Initiative
Communication of Agenda and Goals with Mentor Prior to Meetings
The Practice of Self-Reflection
Clarify Professional Values
Willingness to Move Beyond Comfort Zone
Interest in Collaborative Work with Mentor
Openness to Hearing New Idea and Perspectives
Receptiveness to Constructive Feedback
Other

5. What would be your preferred method of communication with your protege(s)? (Select only one)

Email
Phone
In person
Skype/Video Conferencing

6. When you think about communicating with your protege, how do you envision the relationship? (Select only one)

More Casual - we'll contact each other when we want to talk, knowing that the other person will be available when needed
More Structured - we'll schedule meetings to ensure we keep up with one another
Other

7. Please indicate how interested you are in mentoring junior faculty. (Select only one)

Extremely Interested
Interested
Don't Care Either Way
Disinterested
Extremely Disinterested

8. How many junior faculty would you be able/willing to mentor? (Provide only one response)


9. Please indicate three junior faculty to whom you would like to provide mentorship (Note: this is to assist in preliminary matching of mentors and proteges, and does not guarantee you will be matched with these individuals).


10. Please indicate any junior faculty to whom you would be unwilling to provide mentorship (Note: this is to assist in preliminary matching of mentors and proteges).


11. Please describe what supports will you need to provide mentorship?