*First Name:
*Last Name:
*Business Name:
*Mailing Address:
*City:
- Select -
100 Mile House 108 Mile Ranch 150 Mile House 70 Mile House Abbotsford Agassiz Ainsworth Hotsprings Aiyansh Aldergrove Alert Bay Alexis Creek Alkali Lake Altona Anahim Lake Anglemont Anmore Annacis Island Argenta Armstrong Arras Ashcroft Aspen Grove Athalmere Atlin Avola Baldonnel Balfour Bamfield Barkerville Barriere Bear Lake Beaverdale Beaverdell Belcarra Bella Bella Bella Coola Big Lake Black Creek Blind Bay Blind Channel Blubber Bay Blue River Boston Bar Boswell Bowen Island Bowser Brackendale Brentwood Bay Brideville Bridge Lake Brisco Brittania Beach Brookmere Buffalo Creek Buick Burnaby Burns Lake Burton Cache Creek Campbell Island Campbell River Canal Flats Canim Lake Canoe Canyon Cassidy Castlegar Cawston Cecil Lake Cedar Cedarvale Celista Central Saanich Charlie Lake Chase Chemainus Chetwynd Chilanko Forks Chilliwack Christina Lake Clayhurst Clearbrook Clearwater Clinton Cloverdale Coal Harbour Coalmont Cobble Hill Coldstream Colwood Comox Coombs Coquitlam Cortes Island Courtenay Cowichan Bay Cranbrook Crawford Bay Crescent Spur Crescent Valley Creston Crofton Cultus Lake Cumberland Curzon D'Arcy Darfield Dawson Creek Dawson Landing Dease Lake Delta Denman Island DeRoche Desroche Dewdney Dog Creek Dome Creek Douglas Lake Duncan Dunster Eagle Bay Eagle Creek Earls Cove Edgewater Edgewood Egmont Elkford Elko Endako Enderby Erickson Errington Esquimalt Fairmount Hotsprings Falkland Fanny Bay Farmington Fauquier Fernie Field Forest Grove Fort Fraser Fort Langley Fort Nelson Fort St. James Fort St. John Fort Steele Francois Lake Fraser Lake Fruitvale Fulford Gabriola Galiano Island Galloway Gang Ranch Garden Bay Garibaldi Highlands Genelle Germansen Landing Gibsons Gilles Bay Gitanmaax Gitanyow Gitsegukla Gitwangak Gitwinksihlwk Glen Vowell Gold River Goldbridge Golden Goodlow Grand Forks Granisle Granthams Landing Grasmere Gray Creek Greenville Greenwood Grindrod Groundbirch Gulf Islands Hagensborg Hagwilget Halfmoon Bay Hanceville Haney Harrison Hot Springs Harrison Mills Harrogate Hartley Bay Hazelton Hedley Hefley Creek Heriot Bay Hixon Holberg Honeymoon Bay Hope Hornby Island Horsefly Houston Hudson's Hope Huntingdon Iax Kw'alaams Invermere Iskut Jaffray Joe Rich-Ellison Jordan River Juskatla Kaleden Kamloops Kaslo Keats Island Kelowna Kemano Keremeos Kimberley Kincolith Kingcome Inlet Kingsgate Kispiox Kitchener Kitimat Kitimat Village Kitkatla Kitselas Kitsumkalum Kitwanga Kleena Kleene Klemtu Knutsford Koksilah Kootenay Bay Kuper Island Kyuquot Lac La Hache Lac Le Jeune Ladner Ladysmith Lake Country Lake Cowichan Lake Errock Lakeview Heights Langley Lantzville Lasqueti Lavington Lazo Likely Lillooet Lindell Beach Lions Bay Lister Little Fort Logan Lake Lone Butte Longworth Louis Creek Lower Nicola Lumby Lund Lytton MacKenzie Madeira Park Mahood Falls Malahat Malakwa Malkawa Manning Park Manson Creek Mansons Landing Maple Bay Maple Ridge Mara Marysville Mason's Landing Masset Matsqui Mayne Island McBride McClure McLeese Lake McLeod Lake Meadow Creek Merritt Merville Mesachie Metchosin Meziadin Lake Mica Creek Midway Mill Bay Milner Minstrel Island Mission Moberly Lake Monte Creek Monte Lake Montney Montrose Moricetown Mount Currie Mount Lehman Moyie Muncho Lake Nakusp Namu Nanaimo Nanoose Bay Naramata Nazko Nelson Nemiah Valley New Aiyansh New Denver New Hazelton New Westminster Newton Nimpo Lake North Burnaby North Cowichan North Delta North Hazelton North Pine North Saanich North Shuswap North Surrey North Thompson North Vancouver Oak Bay Ocean Falls Okanagan Centre Okanagan Falls Oliver Ooona River Osoyoos Oyama Oyama Panorama Parksville Parson Pavilion Peachland Pemberton Pender Island Penny Penticton Pinanton Lake Pink Mountain Pitt Meadows Port Alberni Port Alice Port Clements Port Coquitlam Port Edward Port Hardy Port McNeill Port Mellon Port Moody Port Neville Port Renfrew Port Simpson Pouce Coupe Powell River Prespatou Prince George Prince Rupert Princeton Pritchard Procter Progress Prophet River Quadra Island Qualicum Beach Quathiaski Cove Quatsino Queen Charlotte City Queen Charlotte Islands Quesnel Quilchena Radium Hot Springs Refuge Cove Revelstoke Richmond Riondel Riske Creek Rivers Inlet Roberts Creek Robson Rock Creek Rolla Rose Prairie Rosedale Rossland Royston Rutland Saanich Saanichton Saanichtown Salmo Salmon Arm Salmon Valley Salt Spring Island Saltery Bay Sanspit Sardis Saturna Island Savona Sayward Sechelt Seton Portage Sewell Inlet Shalalth Shawnigan Lake Sicamous Sidney Silver Star Mountain Silverton Simoon Sound Sinclair Mills Sirdar Skidegate Skookumchuk Slocan Slocan Park Smithers Sointula Sooke Sorrento South Delta South Hazelton South Saanich South Slocan South Surrey Southbank Southview Spallumcheen Sparwood Spenses Bridge Spillimacheen Spuzzum Squamish Steveston Stewart Stuart Island Sullivan Bay Summerland Summit Lake Sunset Prairie Surge Narrows Surrey Ta Ta Creek Tahsis Takla Landing Takysie Lake Tappen Tatla Lake Tatlayoko Lake Taylor Telegraph Creek Telegraph Crove Telkwa Terrace Texada Island Thetis Island Thornhill Tiell Toad River Tofino Tomslake Topley Trail Tsawassen Tulameen Tumbler Ridge Two Mile Ucluelet Union Bay Upper Fraser Valemount Vallican Van Anda Vananda Vancouver Vanderhoof Vavenby Vernon Victoria Waglisla Walachin Wardner Ware Warfield Wasa Wells West Vancouver Westbank Westbridge Westholme Westwold Whaleton Whalley Whistler White Rock Whonnock Williams Lake Willow River Windermere Winfield Winlaw Winter Harbour Wonowon Woss Wynndel Yahk Yale Yarrow Ymir Youbou Zeballos
*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.
Section 2 – Business Information:
*Business industry:
- Select -
Hospitality
Manufacturing
Retail
Service
Wholesale
*Business sector:
- Select -
Accountant
Agriculture
Animal Care
Arts
Automotive
Beauty
Business/Office
Child Care
Cleaning
Clothing
Construction Trades
Consulting/Contract
Crafts/Hobbies
Education
Environmental
Financial
Food/Beverage
Health Care
Horticulture
Legal
Media
Recreation/Leisure/Entertainment
Technology
Tourism
Other
*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.
- Select -
Cashflow and/or budgeting
Marketing and/or promotion
Networking
Organization and administrative skills
Overcoming cultural barriers
Sales Strategies and Tactics
Satisfaction in work/life balance
Strategic planning for business growth
Understanding Financial Statements and/or legal documents
Other, please explain
*2.
- Select -
Cashflow and/or budgeting
Marketing and/or promotion
Networking
Organization and administrative skills
Overcoming cultural barriers
Sales Strategies and Tactics
Satisfaction in work/life balance
Strategic planning for business growth
Understanding Financial Statements and/or legal documents
Other, please explain
*3.
- Select -
Cashflow and/or budgeting
Marketing and/or promotion
Networking
Organization and administrative skills
Overcoming cultural barriers
Sales Strategies and Tactics
Satisfaction in work/life balance
Strategic planning for business growth
Understanding Financial Statements and/or legal documents
Other, please explain
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.
- Select -
Act as a sounding board
Assist in finding appropriate resources
Build confidence in other women
Give back to my community
Help mentees find focus
Offer guidance
Offer support
Share my experiences and knowledge
Other, please explain
*2.
- Select -
Act as a sounding board
Assist in finding appropriate resources
Build confidence in other women
Give back to my community
Help mentees find focus
Offer guidance
Offer support
Share my experiences and knowledge
Other, please explain
If other, please explain:
*How much time are you able to commit on a monthly basis?
- Select -
1 hour
2 hours
3 - 5 hours
5 - 10 hours
*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?
- Select -
Advertising
An event (e.g. seminar, workshop, tradeshow.)
Chamber of Commerce
Community Futures
Referral from government service
Women in Business Network
Women's Enterprise Centre Website
Word of mouth
Other
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 201.