ChickTech Portland Mentor Registration
Thank you for your interest in being a mentor through ChickTech Portland's High School program! Your involvement may make an enormous difference to a young woman and to the evolution of the tech community.

Please complete this brief application form if you are interested in being a mentor for the 2016-2017 cohort. The mentorship program extends from November through May, and the expected minimum commitment is 4 hours a month.

Once you have completed this application, a ChickTech program manager will contact you with more information, including application, training, and background check requirements.

First name
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Last name
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Please provide your personal email address rather than a work or school email address.
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Phone number
Please provide your cell phone number.
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Please briefly describe your technical experience and knowledge--professional, educational, or other--that may be applicable to your role as a mentor.
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Why are you interested in being a mentor with ChickTech's High School program?
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Please briefly describe your job/work. If you are currently in school, please describe your area of study.
Your answer
Mentors must be able to commit to each of the following for the duration of the mentorship program. Please check EVERY item to indicate your willingness and ability to commit to:
If you wish to participate in the mentorship program, please read and check every item below.
Any questions we can answer?
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