Mentor Application Form: Silicon Slopes Women In Leadership Mentorship Program
Welcome to the Mentor Questionnaire for the Silicon Slopes Women In Leadership Mentorship Program. Your participation in this questionnaire will help us enhance the pairing process between mentors and mentees. By applying to become a mentor, you are making a commitment to actively engage with your mentee and offer consistent guidance and support throughout the program's duration. Additionally, you agree to adhere to all mentor expectations outlined by the Silicon Slopes Women in Leadership Community. Your input will play a vital role in shaping meaningful mentorship connections within our community.
Name
First Name
Last Name
Email
example@example.com
What industry best matches your current career?
Tech
Marketing
Beauty
Human Resources
Sales
Administration
Hospitality
Finance
Design
Education
Other
Would you like your mentee to be in the same industry as you are?
Please Select
Yes
No
N/A
Work experience (number of years in current industry)
<5
5-10
10-15
15-20
20-25
>25
If you have a preference for your mentee's career level, please indicate below:
Entry level
Mid-career
Senior
Executive
n/a
Other
What is your professional background, job roles, and areas of expertise?
Please rank your areas of expertese (1 being least interested, 5 being most interested):
Rows
1
2
3
4
5
Career change or advancement
Professional and/or personal development, work-life balance, personal branding
Entrepreneurship
Certifications, higher education, or technical skills
Leadership and negotiation skills
What motivates you to become a mentor?
What do you hope to gain from the mentorship experience?
What specific knowledge, skills, or insights do you believe you can offer to a mentee?
Have you served as a mentor before?
Please Select
Yes
No
How often do you want to be in contact with your mentee?
Once a week
Every other week
Please select days and times that suit your schedule best:
Rows
8 am - 12 pm
12 pm - 4 pm
4 pm - 8 pm
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Do you have any additional availability other than what's specified above?
Meeting format preference:
Please Select
Virtual
In person
n/a
If you selected in person above, please indicate the distance you are willing to travel to your meetings:
Please Select
<5 miles
5-10 miles
10-15 miles
15-20 miles
>20 miles
Please specify your city for in person meetings:
What resources are you hoping we could help provide to help you be a successful mentor?
Any additional information you'd like us to know about you?
Would you like to be added to our networking contact list that will be shared with other mentors and mentees?
Yes
No
Submit
Should be Empty: