IMPACT Mentorship Program - Mentee Interest Form
By completing this form, you are expressing interest in being a mentee as part of the 2023 IMPACT Mentorship Program.
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Name (Last, First) *
Company Name *
Position / Title *
Email Address *
Phone Number *
Linkedin URL (optional)
What is your background? *
Use this section to briefly describe your personal, professional, leadership, and philanthropy background.
What are 3 goals (personal or professional) would you like to get out of this mentorship program? (please list) *
Areas of Interest *
Check all that apply
Required
Industry Experience *
Select all industries you have experience
Required
What methods of contact do you prefer? *
Required
Would you see additional value in being mentored by a male or female? (please choose)
Clear selection
Do you agree to abide by the requirements outlined by the YP Mentor Program and commit at the minimum of one with my mentor per quarter and the mix and mingle event in November? *
Submit
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