Mentor Application Username* First Name* Last Name* E-mail Address* Password* Confirm Password*Title Address City/State Phone Number LinkedIn AboutHow would you like to help our entrepreneurs? (Select all that apply)Connector (e.g., willingness to help entrepreneurs connect with industry expertise)Coach (e.g., work with early-stage entrepreneurs, asking questions to challenge and guide)Mentor (e.g., a sounding board for strategy and direction, using experience to support and assist)Investor (e.g., potentially investing or being a board member in a new venture)Best Time of Year to MentorSpringSummerFallWinterIdeal Amount of Time to Mentor Per Month2-4 hours5-10 hours10-15 hoursAs availableIndustries (Select All That Apply) Agriculture, Forestry, Fishing and Hunting Utilities Computer and Electronics Manufacturing Biotech Wholesale Transportation and Warehousing Software Broadcasting Other Information Industry Real Estate, Rental and Leasing Primary/Secondary (K-12) Education Health Care and Social Assistance Hotel and Food Services Legal Services Military Other IndustryFunctional Expertise (Select All That Apply)Finance | AccountingMarketingSalesDevelopmentCustomer ServiceConsulting | TrainingHuman ResourcesLegal | ContractsTechnology Maturation and Commercialization (Bring new products to market successfully)Primary Role (Select One)Senior ManagementMiddle ManagementIndependent ContributorTechnology Expertise (Select All That Apply)SoftwareHardwareAIInternet of Things (IoT)Machine learningCybersecurityRoboticsVirtual reality / augmented realitySaaS | CloudBlockchainOtherPreferred communication methodsEmailTextTelephoneIn-personDescribe in 4-6 sentences the ideal startup to mentor.*Describe in 4-6 sentences the ideal founder to mentor.*How many startups have you worked at or advised?1-23-55-1011+Can you challenge assumptions when you feel a founder is headed down the wrong path? yesnoCommentsCan you be supportive, listen carefully, and provide and hear constructive feedback?yesnoCommentsDo you have the desire and ability to give back?yesnoCommentsDo you consider yourself someone who displays innovative thought and forward thinking?yesnoCommentsWould you feel comfortable discussing your leadership and organizational cultural values with startup founders?yesnoComments Only fill in if you are not human Login
