Mentor Committment Form

Thank You for your Support!

Thank you for considering/committing to support the Georgia Mentor Protégé Connection with your time and talent serving as a mentor corporation or sponsor. Please take a moment to complete the following form for our records.

Question Title

1. Please provide us with your contact information

Name: *

Company: *

Address: *

Address 2: *

City/Town: *

State: *

ZIP: *

Title

Email Address: *

Phone Number: *

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2. Please provide a secondary contact from your organization

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Title:

Email Address:

Phone Number:

Question Title

3. In what capacity will you or your Corporation support the Program? Check all that apply. The minimum commitment is a $2500 Sponsorship.

Not sure yet, let's discuss

As a Corporate Mentor ( Commit to 12 months of monthly mentoring and reporting sessions)

Agree to mentor 1 business

Agree to mentor 2 businesses

Sponsor at $15,000-Premier Level

Sponsor at $10,000- Platinum Level

Sponsor at $5,000- Diamond Level

Sponsor at $2,500- Gold Level

Alumni Sponsor- Discuss with Program Director

Other sponsorship amount ( specify amount in "other" field")

Are you willing to provide space/ support for additional program events

Other (please specify)

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4. Please share your preference as it relates to the type of business to develop. Example, any small business, professional services, construction, etc. please be as specific as you can.

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5. Will you be nominating a small business for the Program?

Yes

Maybe

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6. Would you be interested in any of the following? Check all that apply.

Being a "veteran coach" to a "new mentor"

Yes, I'd like to get paired with a veteran coach (for new mentors 1-2 years)

Training on Mentoring A Small Business

Training on Small Business Resources

Training on Leadership/Leadership Development

Other (please specify)

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7. Will you be able to identify the necessary subject matter experts within your organization to further develop your protégé in the disciplines below? Please check all that apply- those left blank we will assist you with to help round out the program.

Strategic Planning

Finance

Sales

Marketing

Technology

Operations/Infratstructure

Other (please specify)

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8. Do you plan to provide supplemental training to your protégé (internal or external) related to your specific industry?

Internal industry related seminars

SBDC "Grow Smart Program"

Leadership Training & Events

Dartmouth, Tuck School of Business

Kellogg

PMP Training

Whatever the program recommends

Question Title

9. What is your motivation for mentoring in our program?

Helping businesses grow

Understanding small business challenges

Developing future suppliers

Its a work requirement

Demonstrating good will/ corporate responsibility

I enjoy mentoring others

I enjoy the program

Networking

Question Title

10. Would you like to offer any training to our protege class or alumni? If so, share with us what type of training. Examples ( Marketing, Risk Management, Bid Proposal Writing, Innovation, etc)

YES

MAYBE

If you responded Yes or Maybe please share your type of training or discussion

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11. For veteran mentors: How has serving as a mentor/supporter of MPC enriched you this year? If it hasn't, share with us some ways we might accomplish that objective.

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12. For new mentors: What expectations do you have for the upcoming experience of mentorship in our program?

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13. Would you be willing to serve on one or more of the following committees? Check all that apply

MPC Ambassador ( help us spread the word on the program, recruit new protégés and mentors)

Annual Retreat & Expo ( assist with providing recommendations of speakers, topics etc final decisions by program)

Alumni Network ( assist in getting this 200+ alumni initiative off to a great start)

Host an event ( whether its a holiday event, supplemental workshop, program kick-off or graduation)

Be a sounding board/advisor

Question Title

14. Would you like information on Best Practices for Mentoring Small Businesses?

YES

Maybe

Other (please specify)

Thank you for completing this quick survey!