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2024 EBL Mentorship Program
1.
Contact Information
Name
Company
Address
Address 2
City/Town
Country
Email Address
Phone Number
2.
Are you a member of the Henry County Chamber of Commerce?
Yes
No
3.
What industry/business are you in (e.g., real estate, manufacturing, finance)?
4.
What is your role?
Business Owner
Employee
5.
How long have you been employed/in business?
6.
Please share your background, interests, and hobbies with us.
7.
Do you want a mentor in the same industry or similar industry?
Same Industry
Similar Industry
Not in Same or Similar Industry
Other (please specify)
8.
Tell us what you would like to gain from your mentor? What would like to learn? What kind of assistance are you looking for?
9.
Are you willing and able to commit to a five-month program with meetings twice a month?
Yes
No
10.
Do you prefer your mentor be male or female?
Male
Female
No Preference
11.
Are you a Veteran?
Yes
No
12.
Which race or ethnicity best describes you?
White
Black or African American
Hispanic or Latino
Asian or Asian American
American Indian or Alaska Native
Native Hawaiian or other Pacific Islander
Another race
13.
Based on generations, which age group do you identify with?
Millennials: Born 1981-1996
Generation Z: Born 1997-2012
Other (please specify)
14.
Is there anything else you would like to share with the review committee?
