Mentor Application and Information Form
Mentors are essential to our programs.  Please keep record of your time and report it to SMTEC monthly by completing the In-kind Service Contributions Form at or by sending the information you recorded via email to  All of your time and efforts are greatly appreciated by us and by our Cohorts.  Thank you very much for your contributions to our successful community programs.
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First Name *
Last Name *
Phone *
Email Address *
Mailing Address *
City, State Zip *
Mentor Classification *
Select all that apply to you
Startup Expertise
Please complete this section if you are a Startup Expert. Select all that apply.
Knowledge Expert
Please complete this section if you are a Knowledge Expert.  Select all that apply.
Industry Expert
Please complete this section if you are an expert in one or more industries. Select all that apply.
Please indicate programs in which you plan to participate. *
Please indicate your mentoring commitment/s. *
What do you hope to take away from this mentoring opportunity? *
Please indicate best time periods for your availability:
7am - 12pm
12:01pm - 5pm
5:01pm - 9pm
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