CCWE

Chatham University Center for Women Entrepreneurship

Mentoring for Women Business Owners Program 2008-2009

Mentor Application Form
Thank you for your interest in participating in the twelve month Mentoring for Women Business Owners program at the Center for Women’s Entrepreneurship at Chatham University. This program is being made available through the support of the Claude Worthington Benedum Foundation.

Your active and engaged participation is the key to our success. Please complete the information below as completely and accurately as possible. This will allow for the best possible match based on your strengths and interests. Mentors and Mentees will have monthly meetings, in addition to two program events yearly.

PERSONAL INFORMATION

Your Name :

Area of Expertise :

Please be specific: Marketing Consultant, Contract Attorney, Recruiter

Degrees :

BUSINESS ADDRESS INFORMATION

Company Address :

Address :

City :

State :

Zip Code :

Business Phone :

Fax Number :

Email Address :

Job Title :

Firm Information :
Check all that apply

	Entrepreneur
	Small (less than 100 Employees)
	Medium (less than 500 Employees)
	Large (500+ Employees)
	Government
	Non-Profit
	Corporate

Length of time in this field : ex. 10 years

Why are you interested in becoming a mentor?

Please list any previous mentoring experience.

If you have personally experienced mentors, in what ways have they helped you?

How do you plan to fit the mentee needs into your already busy life?

What competencies and skills do you have that you think are valuable in a mentoring relationship?

What do you feel is the most important skill or experience you have to offer another growing business owner?

Comments?

Preferred Phone Number to Best Reach You :

Preferred Email Address to Best Reach You :

Please attach a current resume a link to your company websites. We truly appreciate your interest in our program and we will be contacting you soon.


	Center for Women’s Entrepreneurship at Chatham University Braun Hall • Woodland Road • Pittsburgh, PA 15232-9910 (412) 365-1253 (phone) • womens-entrepreneurship@chatham.edu