Name *

Are you applying to be a mentee or mentor? *—Please choose an option—MenteeMentor

Date of Birth *

Age *

Do you currently live, work, or attend school in Antelope Valley, California? *
If no, please contact us for more info. We currently serve the Los Angeles County.—Please choose an option—YesNo

Email Address *

Phone *

Mailing Address *

How did you find about us? *

Why do you want to become a mentor? *

What do you hope to get out of the mentoring experience? *

Do you have any previous experience volunteering or mentoring? If so, please describe. *

What industry or field is your specialty? *

Which SMM program are you interested in? *—Please choose an option—CORE Novice EntrepreneurBRAVO Experienced Entrepreneur

What qualities, skills, or other attributes do you feel you have that would benefit an entrepreneur in formulating and achieving her goals? *

Describe yourself in 2-3 words. *

What are your hobbies and how do you like to spend your leisure time? *

Do you currently have an active business or an employed executive? *—Please choose an option—YesNo

If yes, where?

Please explain any particular issues that would challenge your ability to keep the above commitments. *

Anything else you'd like to share?

Primary Responsibilities: Mentor Application Agreements and Information Release
Please read this carefully before signing:

I understand that information about me will be anonymously (without my name) shared with a prospective mentee to aid in determining a suitable match. Once a mentor/mentee match is determined, my identity and any other information about me may be shared with the mentee to ensure and aid in facilitating a safe and successful match relationship.

I agree to hold harmless SHE Mentors Me and SHE Beverage Company (from whom SMM lease space), its officers, agents, and employees from and against all claims, damages and losses, including reasonable attorney’s fees, court costs, and other expenses arising out of or resulting from any acts, errors or omissions of the mentee I am assigned in the performance of the services set forth in the Agreement.

I pledge to abide by all the rules and policies regarding SHE Mentors Me.

I certify that the information contained on this application is true and correct and that my application may be terminated based on any false, omitted or fraudulent information.

By signing below, I attest to the truthfulness of all information listed on this application, I authorize SHE Mentors Me to verify the information and I agree to all the above terms and conditions.

Sign (Type) your full name and include the date in the box below.