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I Need Mentor

First name*:  
Middle name*:  
Last name*:  
Business name*:  
Contact Information:  
Address:  
Home Phone:   Business Phone:
Email Address:  
Location of business  
Product or service you provide  
Industry sector of your business  
How long have you been in business?  
Where did you hear about the mentoring program?
 Newspaper Add
 YEA publications
 Friend
 YEA event
 Other
Why do you want to participate in the YEA mentoring program?  
Please list the things you’d like your mentor to help you with. What do you expect from a mentor?
What must you demonstrate to them before they are comfortable sharing their networking circles and referring business to you?
Please describe personal and other characteristics you would like your mentor to have:
What are your strengths as a business person?
Would you prefer to have a
Please list any business associations you belong to currently:
Would you prefer to have a protégé within your business sector?  Yes    No
May we give the results of this survey to a potential mentor? Yes    No
   
Please attach a copy of your C.V. with this application or indicate your highest level of education:
 
Attach C.V
Please attach a copy of your C.V. to this application. A member of the YEA mentoring program committee will get back to you within two weeks of submitting this application with the next step of the process. If you are selected to participate in the program you will be required to attend a training program about the mentoring process sponsored by YEA.