Thank you for your interest in becoming a mentor.
Please provide us with the following information.

MENTOR Application Form:

Fields marked with an asterisk (*) are required.

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 (optional), 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.

Please indicate which type of mentoring you would like to be involved with.

*Facilitating a Peer Mentoring Group in your community Yes No
*Being a One-to-One Mentor Yes No
*Offering your expertise in a Mentor Advisory Forum Yes No

Section 2 Business Information:

*Business industry:

*Business sector:

*Please provide a description of your business:
(max 255 characters, or approximately 50 words)

Select your top 3 business strengths or areas of expertise:
*1.

*2.

*3.

If other, please explain: 

*How long have you been in business? since / (Enter as MM/YYYY)

*How many employees do you have? 

What are your reasons for wanting to become a mentor?
*1.

*2.

If other, please explain: 

*How much time are you able to commit on a monthly basis?

*Please provide a brief professional biography:
(max 500 characters, or approximately 100 words)

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

Please use this space to provide us with any additional comments:
(max 500 characters, or approximately 100 words)

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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 104.