ChickTech Portland Mentor Registration
Thank you for your interest in being a mentor through ChickTech Portland's High School program!

Your involvement as a mentor in the 2017-2018 cohort 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 2017-2018 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 *
Your answer
Last name *
Your answer
Email *
Please provide your personal email address rather than a work or school email address.
Your answer
Phone number *
Please provide your cell phone number.
Your answer
Please briefly describe your technical experience and knowledge--professional, educational, or other--that may be applicable to your role as a mentor. *
Your answer
Why are you interested in being a mentor with ChickTech's High School program? *
Your answer
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?
Your answer
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