Fall 2020 Collective Success Network Virtual Mentor Application Form
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Program Description
Thank you for your interest in joining the Collective Success Network Mentorship Program.

Due to COVID19 and concerns about health and safety, our fall mentorship programs will be virtual.  We are also opening up the Mentorship Program to all low-income and/or first-generation college students now living in the greater Philadelphia-area, including those who may be enrolled in colleges outside this region.  

There are currently two different mentorship program tracks:

Track #1: Our General Mentorship Program, which covers a range of relevant topics to help your mentees through their college experience and future professional journeys.   Depanding upon demand, this program can be offered as a Pod (which consists of 2 professionals and 3-4 students), or as a one-on-one.  The general mentorship program meets for 5 sessions (2 hours each) about every other week during the academic semester.

Track #2: Our Career Guidance Program, which matchs junior and senior students with industry specific mentors to help them as they prepare to go on the job market.  The topics are determined by the mentee, but could include helping create job search networks, a resume review, or mock interview.  This program is one-on-one and meets for a minimum of three sessions over the semester.

It is important to know your background and interests so that we can match you with the right student or students.

The application process consists of completing this survey and a follow-up phone conversation (20 minutes). Upon selection into the program, you are expected to attend a MANDATORY virtual orientation session (2 hours) and attend all scheduled meetings.
General Contact Information
Share your contact information so we can know the best ways to reach you
First Name *
Last Name *
Email Address *
Mobile Phone Number *
Home Phone Number
What is your current city and state of residence? *
What is your preferred gender identity? *
What year were you born? *
What ethnicity do you identify with? *
Required
What college did you attend for undergraduate studies? *
What was your field(s) of study for undergraduate? *
Do you have a higher degree? If yes, please share where you went to college for your higher degree.
If you have a higher degree, what degree did you get?
What career fields have you worked in and/or can you provide perspective on? (check all that apply) *
Required
What company/organization do you currently work for? *
How would you describe your role at your current organization? *
How did you hear about the Collective Success Network?
Clear selection
Which Mentorship Program are you interested in?
Would you be willing to be part of the CSN database to be a resource to students who are interested in learning more about your company or field(s) of work? (Only your name, current company of employment, role, professional field(s), and contact information) would be shared). *
Do you have any food allergy or dietary restrictions? *
If you do have any food allergy or dietary restriction please describe
Professional or Personal Reference #1: Name *
Professional or Personal Reference #1: Contact information (email or phone number) *
Professional or Personal Reference #1: Relationship to you *
Professional or Personal Reference #2: Name *
Professional or Personal Reference #2: Contact information (email or phone number) *
Professional or Personal Reference #2: Relationship to you *
Background Information
Share your background information for pod and mentee matching purposes
Hometown *
Occupation *
Position/Title *
Do you identify as: *
Have you been in a mentorship program previously? If you have, please specify the program. *
Please share any insights from your previous mentorship program.
What makes you want to be part of Collective Success? *
What are the 3 reasons for your interest in being a mentor? *
Are there challenges you anticipate in your role as mentor that you would like to see addressed during mentor orientation/training? *
If you are interested in the General Mentorship Pod Program, what 2 hour windows are you available to meet with your pod? (check all that apply) *
Required
Since the Fall 2020 program will be virtual, what platforms are available to you (Zoom, Google Meet, etc.)?
Are you available for one-on-one meetings outside of the mandatory five Pod sessions?
Clear selection
Optional: if there is a mentor that you would like to be paired with in the Pod Program, please share their name here.
Does your company have any connections/partnerships with coop programs or internships? *
Have you ever been convicted of a felony/misdemeanor? *
Are you under current indictment? *
For applicants not associated with sponsor company (PECO, Comcast, or RSM): Are you willing to take and able to pay for a criminal history background check? *
Were you referred to the CSN mentorship program by a previous participating mentee or mentor? If yes, please share their name so they can be entered into a lottery for a cool prize!
Anything else you would like us to know?
If you have a LinkedIn Profile, please share the page here:
By completing this application, I understand that the next step is a follow-up phone conversation (20 minutes). Upon selection into the program, I am committed to a mentor orientation session (3 hours) and 5 pod meetings (2 hours each, approximately every other week) during the academic semester. Failure to participate may result in being removed from the program.                             *
Thank you for completing the mentor application! We look forward to meeting you at a Collective Success event.
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