Mentee: A mentee is someone who believes in personal growth, takes thoughtful risks, and looks for advice and feedback from a more experienced professional. Mentees actively seek advice and guidance from a mentor, and are proactive in the mentoring relationship to ensure success in the partnership.

|Mentee Data |
|Date: December 4, 2012 | |
|Name: LaWanda Pompey |Preferred Name: LaWanda Pompey |
|Job Title: Human Resources Specialist |Corporate Title: |
|Length of Industry Experience: 9 |Email Address: lawandap27@gmail.com |
| |Phone/Mobile Number: 803.917.6840 |
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1. Briefly describe how a mentoring relationship will benefit you at this point in your development and be as specific as possible. Include your specific developmental goals.

2. Although a match cannot be guaranteed, if you would like to suggest an individual(s) whom you would like as a mentor, please do so.

3. Please rank the four heading categories listed below [Professional Development, Diversity, Understanding HRA-NCA’s mission and Leadership] that you would like to focus on with your mentor in order of importance, from 1 being the highest through 4 being the lowest. Then, within each of these four heading categories, check off underneath those headings your developmental needs and areas of interest. Please use the “Other” section under each to list additional items of need or interest that you may have.

|Professional Development RANK __ |
| |Learning how to manage change |
| |Networking within and outside of HRA-NCA |
| |Learning how to give feedback |
| |Learning how to receive feedback and use feedback for growth |
| |Developing effective interpersonal communication skills |
| |Learning to communicate persuasively |
| |Developing effective presentation skills (oral and written) |
| |Understanding my client’s business and identifying their current and emerging needs |
| |Exceeding client expectations |
| |Assessing professional goals realistically and refining them to achieve maximum success |
| |Balancing work-life issues to achieve both professional and personal satisfaction |
| |Other: (Describe) |
|Diversity RANK ___ |
| |Including diverse ideas/opinions and thoughts when exploring action steps |
| |Understanding the diversity of culture both within groups/divisions as well as at a corporate level to strengthen alliances and achieve |
| |greater success as an HR professional |
| |Strengthening interpersonal skills in my personal interactions by pairing with a mentor who has diversity experience, knowledge and |
| |background |
| |Understanding the “business case” for diversity initiatives |
| |Honestly discussing and understanding how diversity challenges and impacts my ability to succeed and achieve my professional goals |
| |Learning how to appropriately challenge perceived barriers that inhibit the full contribution of others |
| |Encouraging the expression of diversity |
| |Other: (Describe) |
|Leadership RANK __ |
| |Translating vision and setting direction |
| |Focusing on results |
| |Exercising sound business judgment |
| |Leading by example |
| |Resolving conflicts |
| |Learning to think strategically |
| |Building ownership and commitment |
| |Taking risks |
| |Initiating and supporting change and innovation |
| |Building strong relationships |
| |Understanding and using technology in your job |
| |Other (Describe): |

4. Professional development requires a willingness to learn by taking risks and accepting constructive feedback. Describe how you prefer to receive feedback and how you would utilize it to increase your success.

5. What concerns, if any, do you have about being involved in this program?

6. What areas of professional development have you and your manager discussed that you would like to receive assistance in from a mentor?

7. The following is a continuum designed to give us some idea as to how you analyze issues and communicate with others. Please check the box where you feel you fit on the continuum.

In the categories listed, I would rate myself as predominately:
|More Like Me |Neutral |More Like Me |
|Assertive | | | | | | | |Subtle |
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|Self Starter | | | | | | | |Like Direction |
|Analytical | | | | | | | |Intuitive |
|Extrovert | | | | | | | |Introvert |
|Vocal | | | | | | | |Listener |
|Creative | | | | | | | |Methodical |
|Explorer | | | | | | | |Focused |
|Decisive | | | | | | | |Thinker |
|Risks | | | | | | | |Cautious |

8. What other factors would you like considered in matching you to a mentor partner (eg. gender, geography, specific department etc.)?
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9. Please provide a brief summary of your background and employment history that can be provided to a mentor with whom you are matched.

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To succeed, a mentoring relationship requires a commitment by both the mentor and mentee to work towards achieving goals that are agreed upon by the pair. To indicate your understanding of this commitment, please read and sign the following:

If accepted as a mentee in the HRA NCA Mentoring Program, I understand that: • I will be required to attend a training session (Date will be announce before pairing); • I will be required to interact with my mentor for one to two hours per month over a 6 month period; • My mentor and I will establish goals to be achieved during our relationship, and I will engage in activities and behaviors designed to reach those goals; • I, together with my mentor, will monitor my progress towards those goals; and • I, together with my mentor, will complete meeting journals, a satisfaction survey and other documentation required by the Program.

LaWanda Pompey
Signature

Thank you for your interest in the HRA-NCA Mentoring Program. Return your completed form by email to info@hra-nca.org. You will receive an email confirmation once your application has been received and again if you have been accepted into the program.