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 the Women’s Enterprise Centre monthly newsletter and small business updates?
Yes No

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.