Thank you for your interest in the Northeast Michigan Mentorship Cohort Program. This program is designed to support business owners, professionals, and emerging leaders through structured mentorship, peer learning, and practical skill‑building. Your feedback will help us shape a program that is relevant, valuable, and realistic for our region.
About You & Your Business

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* 1. Business Name

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* 2. Licensing and Regulatory Affairs (LARA) ID

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* 3. Is your business currently in good standing?

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* 4. Business Structure

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* 5. Your Role:

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* 6. Industry

Your Interest in Mentorship Cohort

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* 7. How interested are you in participating in a mentorship cohort?

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* 8. How would you most likely participate? (select all that apply)

Learning Topics & Priorities

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* 9. What topics would you most like to learn about through a mentorship cohort? (Select up to 5)

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* 10. What challenges are you currently facing that mentorship could help with?

Time Commitment & Format

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* 11. How much time could you realistically commit to this program?

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* 12. Preferred meeting format:

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* 13. Best time for meetings: (Select all that apply)

Program Value & Expectations

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* 14. What would make this mentorship program valuable for you or your business?

Next Steps

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* 15. Would you like to receive more information or be contacted about this program?

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* 16. Preferred Contact Information: (Name, Email, Phone)

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