Please provide us with the following information and we will get back to you as soon as possible.

Taking the Leap to Entrepreneurship Mentoring Program is partially funded by the Ministry of Jobs, Tourism and Innovation. The cost of the Mentoring Program is $150 per person.

In order to be eligible, you must be a woman in the early stages of operating a business, located in the province of British Columbia, over the age of nineteen and legally able to work in Canada. If you meet the eligibility criteria, we will contact you to set-up a phone interview. If your phone interview is successful and you are accepted into the Mentoring Program, your payment will be due within five business days of receiving the acceptance letter. Your place in the program will only be secure once the payment of $150 has been made.

MENTEE Application Form:

Fields marked with an asterisk (*) are mandatory.

Section 1 - Personal Information:

*First Name:

*Last Name:

*Business Name:

*Mailing Address:

*City:

*Postal Code:
-

*Contact Telephone:
-- (Enter as xxx-xxx-xxxx)

*Primary E-mail:

For statistical purposes, please indicate if you are:
 Aboriginal
 Immigrant - If so, how many years have you been in Canada? years.

*Would you like to receive:

Yes No
eNews – 9x per year publication filled with information and announcements of events relevant to women entrepreneurs and small business owners.
Yes No
eBlasts - targeted emails with information on upcoming events of interest to entrepreneurs and small business owners in your area. Frequency of these emails varies throughout the year.
Please note that you may update your subscription preferences at any time through the WEC website.


Section 2 – Eligibility Information:

*All participants must be at least 19 years of age. Please indicate your birth date:
// (Enter as DD/MM/YYYY)

*Please indicate your business start date:
/ (Enter as MM/YYYY)

*Indicate which phase your business is currently in:
 Pre Start-up – I haven’t launched my business yet. I am in the research, planning and business development stage.
 Start-up – I am actively operating my business and generating revenue.
 Early Growth Stage – My business is building momentum and I am anticipating expansion and/or increases in product/service demand.

*From what background are you transitioning into self-employment/business ownership?
*

If other, please explain: 

*What is the highest level of formal education you have attained:

*On a scale of 1 to 4, with 1 being low and 4 being high, how would you rate your confidence level in managing all the aspects of your business and the business challenges you are facing:
one (low)   two   three   four (high)  

*What are the top three challenges that you face in developing your business?
*1.

*2.

*3.

If other, please explain: 


Section 3 – Program Information:

The following information about your business will assist us in placing you in the appropriate mentoring format – group or one-to-one.

*Business Industry:

*Business Sector:

*Brief description of your business:

*Are you operating your business full time or part time?
Full Time Part Time

*How many hours a week do you typically spend working in your business?
 (hours/week)

*What are your average gross monthly sales?
$ (monthly sales)

*Please provide us with the top three business goals you wish to achieve:

*Which benefits do you hope to receive from participating in this program? (please choose 2)
*1.

*2.

If other, please explain: 

*The flexibility of your schedule helps us to serve you better. When are you available to meet with your Mentor (approx 2 – 3 hours)?
Select all that apply:

 Morning
 Afternoon
 Evening
 Weekend

*How did you hear about Women's Enterprise Centre's Mentoring Program?

Please indicate if there is someone in your community who you would like Women’s Enterprise Centre to approach on your behalf to become your mentor.
Name:

Business:

Telephone:
-- (Enter as xxx-xxx-xxxx)

Please use this space to provide us with any additional comments:

 

WOMEN’S ENTERPRISE CENTRE

Collection and Use of Information

I have answered all questions on this form and certify that all information I have provided is complete and accurate.

I understand the Women's Enterprise Centre, through the Province of British Columbia, receives funding for this program from the federal government as a result of the Canada-BC Labour Market Agreement.

I understand that information I have provided on this form or that has been collected about me during my participation in this program will be available to the Ministry of Jobs, Tourism and Innovation who is the provincial oversight for the Canada-BC Labour Market Agreement.

I understand the Ministry of Jobs, Tourism and Innovation is responsible for fulfilling reporting obligations under section 30 of the Canada-BC Labour Market Agreement, however, no personally identifiable information about me will be exchanged with the federal government to fulfill this requirement.

I consent to being contacted by the Ministry of Jobs, Tourism and Innovation (or its agent) at intervals and up to 12 months after completion of my participation in this program for the purpose of program evaluation.

Collection and Use of Information. All information is collected pursuant to section 26(c) of the Freedom of Information and Protection of Privacy Act. The information provided will be used for administrative and evaluation purposes of this program. If you have any questions about the use of this information, contact the Manager, Skills Development, Women's Enterprise Centre (250) 868-3454.


*I have read and agree with the terms and conditions of the Collection and Use of Information as outlined above: 

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*Type in the validation code from the image above. It is case sensitive.

If you would like to speak with us about this application form, or if you have any questions, please call our Mentoring Program Coordinator at Women's Enterprise Centre, 1.800.643.7014 Extension 205.