Mentor Interest Application Please complete the following application to become a program mentor. Full Name: Title First Name * Last Name * Suffix Contact Email Address: * Contact Phone Number (mobile preferred) * Mailing Address Address Line 1 * Address Line 2 City * State * Select option... Alabama Alaska Arizona Arkansas California Colorado Connecticut DC Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming DC Zip/Postal Code * What interest you about being a Mentor? * Have you had previous experience with mentorship before? If YES, please give a summary of your experiences: * What business/industry are you currently serving? * Please list some natural abilities: (i.e.. working with numbers; good with people) * Identify some specific strengths you exhibit in the workplace: i.e.. Verbal communication; emotional awareness; problem-solving; optimism, etc.): * What specific soft skills are considered strengths for you? (I.E. Compassion; problem-solving; good listener; provides sound advice). * Brief biography with selected work experience that we can share with your student mentee: * Please share your headshot or professional style photo: * Program Requirements: I understand I am committing to a 6-month mentoring program with bi-monthly meetings with a student mentee in addition to the open and closing events. As part of the program, I understand I will need to share updates monthly with Chamber staff for reporting purposes. * I understand and agree