Ageless Innovators Cohort 11 Application

Ageless Innovators is Chicago's first intergenerational co-mentoring program, connecting successful innovators across generations and across businesses to provide reciprocal, mutual learning. The community that has developed is one that inherently values the diversity of perspective.

This cohort will run from January-June 2024. Co-mentors will be expected to commit to around 10 hours with their co-mentor partner over the course of this 6-month period.

If accepted into the program, you will be paired with a successful innovator of a different generation based on what you hope to learn and teach. Click here to find a FAQ sheet.

The application deadline is end of day Tuesday, October 17. Please email Laura at lauraj@chicagoinnovation.com if you have any questions.

This application is free. If accepted into the program, there is a $150 enrollment fee.

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* 1. First Name

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* 2. Last Name:

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* 3. Pronouns

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* 4. Which age bracket are you a part of?

Born 1928 - 1945

Born 1946 - 1964

Born 1965 - 1980

Born 1981 - 1996

Born in or after 1997

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* 5. Please choose the option(s) which best describe your race and ethnicity.

Asian or Asian American

Black, African, or African American

Hispanic or Latine

Middle Eastern

Native American, First Nation, or Indigenous American

Native Hawaiian or Pacific Islander

White or European American

Other (please specify)

None of the above

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* 6. Preferred Email Address

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* 7. Preferred Phone Number

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* 8. Job Title

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* 9. Company/Organization Name

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* 10. Brief Career History (companies and titles) or link to Personal Website/LinkedIn

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* 11. What do you hope to gain from participating in the mentorship program?

A new friend / trusted colleague

A support system

An expanded professional network

Professional Development

Other (please specify)

None of the above

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* 12. What is a measurable goal(s) that you would like to reach during the six-month program? (Please be as specific as possible, e.g. learning how to network by attending events, practice pitching a new business, I would like to change industries by the end of the year).

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* 13. What topic, skill, or perspective are you most interested in SHARING with your co-mentor?

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* 14. What topic, skill, or perspective are you most interested in LEARNING from your co-mentor?

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* 15. How do you like RECEIVING feedback?

In person, so we can discuss

In writing, so I can plan my response

Both are fine!

Prefer Not to Answer

Other (please specify)

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* 16. How do you like GIVING feedback?

In person, so we can discuss

In writing, so they can plan their response

Both are fine!

Prefer Not to Answer

Other (please specify)

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* 17. How would you like to communicate with your co-mentor?

	Yes	No
Video Call (e.g. Zoom, Google Meets)	Video Call (e.g. Zoom, Google Meets) Yes	Video Call (e.g. Zoom, Google Meets) No
In person	In person Yes	In person No

Other (please specify)

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* 18. If you can meet in person, what areas would be the most ideal/easiest for you to meet with a co-mentor? (e.g. downtown, western suburbs, north side, etc.)

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* 19. What are your hobbies?

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* 20. Please share with us any additional ways you can contribute to Ageless Innovators (hosting an event, speaking at an event, etc)

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* 21. Is there any additional information that you would like us to know about your interest in joining Ageless Innovators? Please share anything that you think may be helpful in the pairing process, including if there are shared identities that you consider imperative to a positive experience (e.g. race, gender).