FGA Disability Innovation: ADVANCE Mentor Application Form

Instructions:

Thank you for your interest in the Verizon Forward for Good Accelerator, focused on Disability Innovation. The purpose of this application is to gauge your interest in mentoring startups in this program, specifically as a member of Verizon ADVANCE. We also want to gather some brief information about your professional background and why you are interested.

Please complete the below application with as much detail as possible.

Save for later:

This form can be saved and continued at a later date before submitting. To save your responses scroll down to the end of the form and select save. A modal to save your responses will activate midform.

Help & Accommodations:

Thank you for your time! If you have any questions about the form or accessibility needs for either the form or rubric please email curtis@alley.com and kara@alley.com

All fields marked with * are required and must be filled.
Name*

First NameLast Name
Email*
Job Title*
Organization/Team:*
LinkedIn Profile (Optional)
Do you have a lived experience with a disability?*

YesNo
Do you have past experience mentoring startups and early stage companies?*

YesNo
Mentorship can take many different forms. In what ways are you interested to mentor startups and contribute time to this program? Please select all that apply, and note that all opportunities are virtual:*

Meet 1x1 with one startup at least once during the program to share your expertiseMeet 1x1 with multiple startups at least once during the program to share your expertiseSpeak/collaborate on a topic-specific panelOpen your network and make specific connections for the startups (such as business and customer development, hiring needs, investor introductions, and partnership connections)
What business topics/subjects do you have relevant past experience with and would be a focus area for the mentorship you provide? Select all that apply:*

Business and revenue modelsStartup metricsUser testingSales and business developmentFundraisingCustomer discoveryProduct roadmappingFinancial modelingMarketingPitching and storytellingOther
Is there a specific assistive technology area of focus that you have experience with and excited to mentor? (optional)
Why are you passionate about disability innovation, assistive technologies, and/or disability advocacy?*
Can we add you to our mentor newsletter, where you can hear from us about the progress of the startups and their questions for mentors? You can unsubscribe from the newsletter at any time.*

YesNo
Please share any accessibility needs we should be aware of so you can fully participate as a mentor in virtual meetings and all events:
Should be Empty: