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Introduction: The *SPSC Leadership Forum has created a team that is designing and will administer a prototype-mentoring program.  This is something that many employees have requested for some time now. In order to fulfill our design obligations in the best way, we are asking for all interested employees of SPSC to answer the questions on this survey and to provide us with their opinions in the Comments section following each category.  We thank you in advance for your assistance.

Please review the attached description (or news article) before completing the survey. Please answer every item. All responses are confidential.

Sincerely, The Mentoring Design Team
* SPSC stands for Spectacular Products and Services Company. A fictitious Name.

For demographic purposes, please check the boxes that are appropriate:

Last Name: First Name:
Company: Position:
Address: City:
Phone: Fax:


Gender Pay Group Work Location Racial/Ethnic Background
 Male  Exempt  North America  African-American
 Female  Non Exempt  Europe  Asian
     Salaried  Asia  Caucasian
     Hourly  Latin America  Hispanic
             Native American/Eskimo

Category 1. Knowledge of Mentoring

A. I would rate my knowledge of mentoring as the following.

 Excellent  Very Good  Moderate  Poor  No Knowledge


B. My knowledge of mentoring is based upon the following sources of information:
(Please check all that apply).

 Observing others
 in my work unit
 about it
 with peers
 A program in
 our organization
 Television    Internet  Educational
 Please explain



C. My general attitude towards mentoring is:

 Very Positive  Positive  Neutral  Negative  Very Negative


D. Below is a list of common perspectives concerning mentoring.
Please answer True, False or Canít Answer (CA) to the items below:

  T F CA
 Mentoring is only for the High Potential employee.
 Mentoring is for those employees who have not made the grade.
 Mentoring is an effective method of developing your potential.
 Mentoring can only be effective when oneís boss is involved.
 Spontaneous or natural mentoring is best.


Category 2. Experiences with Mentoring
Please answer True, False or Canít Answer (CA) to the items below:

  T F CA
 My Functional Group has a mentoring program.

 Mentoring is freely offered to everyone on an informal basis.

I have been mentored or coached by someone more senior with more knowledge) within the last 1 to 5 years.

I have mentored or coached someone more junior  (with less knowledge) within the last 1 to5 years.

Prior to working at  SPSC, I was in a mentoring program (or relationship).

 If true, what was your role?  Check only one choice as true.



 If other explain:

I have never been involved in a Mentoring Program or mentoring partnership in any capacity.

Currently, my boss (immediate supervisor or manager) is my mentor.


Category 3. The Need for Mentoring at SPSC

  T F CA

This organization supports and encourages the free exchange of information across levels and units.

We are encouraged by management to learn new things

There is a need for mentoring in our organization.

If true, at which level is it needed:

Company wide  


   Division or Department

Functional unit  

There are a number of people inside our company whom I consider to be role models.

I feel comfortable going to the senior members of our group and asking for their input, opinion, etc., on any issue.

My current supervisor freely offers advice and counsel to those who need it.

I am comfortable going to my boss asking for help with a problem that I cannot solve.

My peers are the best source of help and information about jobs, promotions, assignments etc.

I understand the values of our company, organization, etc.

I have a good understanding of the unwritten rules of the organization.


Category 4. Development  Activities Profile

  T F CA
 I am afraid that if I donít upgrade my skills, I will be laid off.
 Within the last two years, I have taken a career workshop within
 the company.

If  true, check only one of the statements.

I found it helpful   


Not helpful   

Somewhat helpful   

 I am currently taking part in a degree or certification program.
 I know what it takes to succeed in this organization.

I have ample opportunity to develop my professional competencies.

I have a long-term career plan on which I am making good progress.

Itís not what you know but who you know that counts in getting raises and promotions.

 At least one of my current assignments stretches my current capabilities.

I have a good idea of how decisions on promotions are made in this


Category 5.  Desired Benefits of Mentoring

Below is a list of some of the more common benefits of mentoring. Please rate the Value of each in the box indicated.  (Values are ranked on a scale from 1 to 5, with 1 being the lowest benefit and 5 being the highest.)

FOR MENTEES (Scale 1-5)

FOR MENTORS (Scale 1-5)

 Learn how to balance work and life  Foster inclusion

Expand knowledge of career path and options

 Enhance awareness of diversity issues

Develop interpersonal and communication skills

 Develop next generation of leaders
 Expand knowledge of the company  Encourage organizational savvy

Gain knowledge of a different function

 Transfer corporate knowledge and values

Improve networking capability

Provide an alternative source of
feedback to mentees

Develop teaming capabilities

 Enhance coaching skills

Improve job satisfaction and morale

Utilize the wealth of professional expertise and experience

 Other: Please specify


 Other: Please specify


Category 6.  Possible Prototype Participation

A. The Mentoring Program will require a time commitment for training, meeting with oneís mentoring partner, and evaluation checkpoints. There may be other activities scheduled by the Mentoring Design Team throughout the year's duration of the prototype. Please review the list of required activities and, taking the perspective of a possible participant, indicate those items that you feel you could participate in and those that you think might create a barrier (explain in comments section).


Information Sessions are open employee forums to explain the Mentoring Program. Each will last approximately 90 minutes long and several will be scheduled at different times during the week. Could you attend one session?


A Barrier




Training sessions are required for all selected participants. The Introductory Session is 6 hours and the Advanced Session is 4 hours. Could you attend one or both sessions? Please indicate?

Both Sessions


Discussions between Mentee and Mentor are recommended for 2 hours per month for the 12-month period of the Program. Could you set aside this much time?

A Barrier


Would you be willing to commit any of your personal time in support of your mentoring partnership?

  • If  OK, what percentage of your time would you devote to your mentoring discussions?
A Barrier


Periodically, there will be checkpoints held to evaluate the progress of the mentoring pairs. At each checkpoint there is an interview or a focus group and a brief on-line questionnaire. Would you be able to set aside the time to participate?

A Barrier

B. My desire to participate in the Mentoring Program is:

 Very High  High  Neutral  Low  Very Low



C. The probability of my applying to the Mentoring Program for the prototype is:

 Very High  High  Neutral  Low  Very Low


D. If I apply, it would be as one of the following:

 Mentee  Mentor  Both


E. Factors that would keep me from applying:  (Check all items that apply)

Time commitment Uncertainty about how it works
Budgetary considerations Not enough information on the program
Lack of functional support for the program Donít know if its right for me at this time

Category 7. Desire for Information

When the Mentoring Program initiates the  application process for its Prototype Program, which of the following would be the best method (s) for you to gain information about the program? Please check off all that apply.
 Address by Chief Executive
 Article in the Company Newsletter
 Brochure distributed to all employees in the pilot sites
 Intranet Website devoted to Mentoring
 Mentoring Information Sessions (or Employee all-hands meetings)
 Mentoring booklet which explains the basics
 Personal stories from those who have been involved in Mentoring.
 Unit or divisional meetings
 Application to the program can be made at meetings and on the web site.



Please use this space to provide us with suggestions for helping us to make this a most successful program.




COORDINATORS PLEASE NOTE: Additional Questions are available for building a customized questionnaire. On-line administration and scoring are available at  www.mentoringanalysis.com. Please call (510) 581-2946 for permission and terms of use for the above questionnaire form.

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