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Peer Resources Network Survey

The purpose of this survey is to gain information about your involvement with coaching, peer assistance or mentoring. In exchange for providing this information, we will add your name to our mailing list and, if your address is in North America, we will send you a complimentary copy of our current publication, Compass: The Magazine for Peer Assistance, Mentorship and Coaching. Persons who live outside North America will receive a complimentary copy of the latest issue of the Peer Bulletin.
The information you provide in this survey will only be made available to other mentor or peer program leaders for networking and program development purposes. We do not distribute this information or our database to any person who is not a member of our Network. The use of any of this information for commercial purposes in prohibited.
If you are concerned about sending personal or financial information over the Internet, please read our privacy statement.

To have your name added to our mailing list and receive a sample copy of Compass: The Magazine for Peer Assistance, Mentorship and Coaching, simply provide the address information requested in Section A below, and complete the relevant questions in Section B, Section C or Section D. Click the send button when you're done.

Section A (General Address Information)

Name (required)
Title
Organization
Department
Street
City
Province/State
Postal/Zip Code
Country (if not US or Canada)
Work Phone (required)
Home Phone (Optional)
Cell Number (Optional)
Fax Number
E-mail address (required)
WWW address

Is this address:
Work
Home
Both

Send me the:
E-version of Compass
Print version of Compass (This version is not available to postal mailing addresses outside North America. Persons with "hotmail" or "yahoo" addresses are not eligible for the print version to be sent to their postal address. A non-binding invoice for membership in the Peer Resources Network will accompany this mailing.)

How did you learn about this website?

Section B (Peer Assistance Program Interest)

If you are involved in or interested in a peer assistance program (peer helping, peer education, peer mediation, etc.), please complete this section.

1. Indicate the phrase that best describes your present peer program status:

Interested Planned Active Past

2. Indicate the number of hours of specialized peer helper training you have received (include courses, lectures, or workshops on peer helping):

No formal training Less than 20 hours About 30 hours Over 40 hours

3. If you are nationally certified as a peer helper trainer, please indicate your level of certification:

Not Certified Level I Level II Level III

4. If you are involved in a peer program, please indicate what you call the people who provide the peer services:

Peer Helpers Peer Counsellors Peer Tutors Peer Support Workers

5. Please indicate the group(s) served by the peer helpers in your program:

6. Please indicate the major activities of your peer helpers:
(If you are using a MAC, you can select more than one category
by holding down the open apple key and using your cursor to
select each category.)

Other special features or services:

Section C (Mentoring Interest)

If you are involved in or interested in mentoring, please complete this section.

1. Indicate the phrase that best describes your involvement with mentoring programs:

Interested Planned Active Past

2. Indicate the number of hours of mentor program training you have received (include courses, lectures, or workshops on mentoring):

No formal training Less than 20 hours About 30 hours Over 40 hours

3. If you have taken a workshop from a National Mentor Program Leader, please specify leader name, place and date:

Name: Place: Date:

4. If you are involved in a mentor program, please indicate what you call the people who receive the services of a mentor:

Mentee Protege Partner

5. Please indicate the group(s) served by the mentors in your program:

6. Please indicate the major activities of the mentors:

Other special features or services:

Section D (Coaching Interest)

If you are involved in or interested in coaching, please complete this section.

1. Indicate the phrase that best describes your involvement with coaching:

Interested
Training to be a Coach
Active Coach
Engage in coach-like work, but do not call it coaching

2. Indicate the number of hours of coach training you have received (include in-person courses, lectures, workshops, telecourses):

No formal training
Less than 20 hours
21-40 hours
Over 40 hours

3. If you have taken most of your coach training from a particular organization, please specify the name of the organization:

Name: Place:

4. If you are a member of a professional coach organization or association, please specify the name of the organization or association:

International Coach Federation
Peer Resources Network
Other

5. Please indicate the primary client group you coach:

6. Based on your coaching experience, what would you say is the most common area in which you assist your clients:

7. Rate the amount of importance you place on coach certification:

Essential
Very Important
Important
Somewhat Important
Not Important

Other special features or coaching services: