2021 Mentoring Program Mentor Application

Mentoring Program Mentor Application

2021 Program
Mentoring Program Mentor Criteria:
- You must be a Tempe Chamber of Commerce member in good standing
- Have at least 5 years of business experience and 2 years of leadership experience
- Have been in your current position for at least 6 months
- Make a commitment to the 6-month program with regular monthly organized sessions and additional independent meetings between mentors and protégés
- If not self-employed, obtain an employer’s commitment to participate in the program
- Be open to self-assessment, self-discovery and the life coach experience and enrichment
- Mentors are responsible for the cost of their ticket to attend the Leadership Speakers Series session on February 11th and for the cost of their tickets to attend the Leadership Conference in May 2022.
- Completed applications must be received by October 22, 2021 .
- Selected applicants may be interviewed for consideration.
Mentor Program workshop dates are:

· Friday 12/10/2021 8:00 - 11:00 am

· Friday 1/14/2022 8:00 - 11:00 am

· Friday 2/11/2022 8:00 - 11:00 am

· Friday 3/11/2022 8:00 - 11:00 am

· Friday 4/8/2022 8:00 - 11:00 am

· Friday 5/13/2022 8:00 - 11:00 am

Graduation Ceremony/2021 Leadership Conference in May 2022.

For more information about this program or if your organization is interested in a sponsorship, please review the Mentoring Program Overview.
MENTOR CONTACT INFORMATION
Name *

First Name Last Name
Company Name *
Your Title *
Company Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Work Phone Number *

Area Code Phone Number
Mobile Phone Number *

Area Code Phone Number
Supervisor's Name (if applicable)

First Name Last Name
Supervisor's Phone Number

Area Code Phone Number
Have you participated in the Tempe Chamber Mentoring Program in the past?

Yes, as a protege Yes, as a mentor No, I have not participated in the past
PREVIOUS EMPLOYMENT

Please supply two previous employers
Employer *
TItle *
Start Date *

Month Day Year
Date
End Date *

Month Day Year
Date
Employer *
TItle *
Start Date *

Month Day Year
Date
End Date *

Month Day Year
Date
EDUCATIONAL HISTORY

List type of degree, major and name of school
High School *
Bachelors/Major
Masters/Major
Doctorate/Major
Professional Certifications/Designations
REFERENCES

List two business professionals who will be contacted to provide information regarding your qualifications as a Mentoring Program participant. If you are not self-employed, please include your supervisor as one of your references.
Reference 1 *

First Name Last Name
Company Name *
Title *
Company Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *

Area Code Phone Number
Reference 2 *

First Name Last Name
Company Name *
Title *
Company Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email *
example@example.com
Phone Number *

Area Code Phone Number
What format are you comfortable using for mentoring workshops?

Virtual In person In person with distancing & masks Either
What format are you comfortable using for mentoring one-on-one meetings?

Virtual In person In person with distancing & masks Either
MENTOR PROFILE
Describe your current role & responsibilities. *
Describe your personal and professional accomplishments. *
Describe any professional development you have been involved in within the past year. (conferences, webinars, books, etc.) *
Describe the leadership skills you would like to share through this program. *
Describe your ideal protege and/or what specific industry or profession you'd like to be paired with. *
What do you hope to gain from participating in the Women in Business Mentoring Program? *
MENTORING PROGRAM AGREEMENT OF UNDERSTANDING

I authorize the Women in Business Mentoring Program Selection Committee to contact the listed references and my current employer. The Mentoring Program may also release, if necessary, information contained in this application. I have read and understood the program commitment and am willing to honor that commitment. I also agree to purchase the speaker series ticket and Leadership Conference ticket. Both will be purchased at a 25% discount.
Applicant Signature *

Clear
If you work for a business/employer, we will require an Agreement of Understanding to be signed prior to your acceptance to this program. This Agreement will state that the employer understands the time commitment and that they agree to provide the applicant with the time away from the workplace to attend all scheduled activities.
Applications must be submitted by October 22, 2021. Any questions or concerns regarding this application can be sent to denise@tempechamber.org.
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Mentoring Program Mentor Application

MENTOR CONTACT INFORMATION

PREVIOUS EMPLOYMENT

EDUCATIONAL HISTORY

REFERENCES

MENTOR PROFILE

MENTORING PROGRAM AGREEMENT OF UNDERSTANDING