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* 1. Please provide your name, position and email address:

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* 2. Are you interested in being a:

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* 3. Are you a:

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* 4. What do you do for work?

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* 5. If you are a business owner, at what stage is your business?

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* 6. If you are a professional, at what stage are you at in your career?

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* 7. Are you looking at a career change?

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* 8. If you are a professional, are you willing to mentor an entrepreneur?

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* 9. If you are interested in possibly becoming a mentee, which topics interest you the most? (Rank in order):

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* 10. If you are interested in possibly becoming a mentor, on which topics do you feel you are most comfortable advising? (Rank in order):

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* 11. Are you interested in leading a workshop? (If yes, please provide the topic in the comments.)

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* 12. If looking to possibly become a mentee, what are you looking for in a mentor?

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* 13. If looking to possibly become a mentor, what do you think you can most offer to a mentee?

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* 14. Every year, we will have two mentorship sessions – September to February, and January to June. Do you have a preference? (If you’re flexible, please let us know, as we will try to even out the participants between both sessions.)

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* 15. Would you be interested in having a group where you can share ongoing thoughts and resources with other participants? If so, what platform would you find most useful?

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* 16. If you are an entrepreneur, what specific information would you like to learn that would be most helpful to you in running your business? (Provide as much detail as you would like):

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* 17. Any other comments:

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