Changemaker Mentorship Program - Member Request Form
The program matches a local expert with a Roundhouse member (you) for a set term where they will work to achieve co-created outcomes.

Please fill out this form to identify your needs and challenges to help us pair you with one of our expert consultants. We'll be in touch to chat about the options available.

Name (first and last) *
Your answer
Organization Name
Your answer
What stage of development is your business in?
What are some of the specific challenges you are facing? Please provide some context and detail for your items. *
Your answer
Select if you would like to be matched for a one-time appointment or a three-month term with the meeting frequency to be determined between the expert and yourself. *
Required
Indicate if there are specific topics you'd like to be matched with. Keep in mind we'll try pairing you with a specialist in their respective field. *
Required
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