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 *

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

Mentor Interest Application

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