SBMI Application Form

1
Are you located in New Jersey or the Greater Philadelphia Area USA?* This field is required.
YESNO
2
First Name* This field is required.
3
Last Name* This field is required.
4
Email Address* This field is required.
5
Phone Number* This field is required.
Area Code
Phone Number
6
How are you interested in partnering?* This field is required.
I'm a business leader interested in serving as a mentor.
I'm a business owner looking for mentorship.
7
Name of Employer
8
Current or Most Recent Position* This field is required.
9
Please list all the industries where you have experience: * This field is required.Include no more than your top five industries.
10
For the following question, please check off the areas you are comfortable mentoring and advising entrepreneurs on:* This field is required.
Leadership and Management
Accounting & Finance
Information Technology
Sales and Marketing
Legal and Governance
Operations and Logistics
Human Resources
Capital Raising
Other (please fill in details on next field)
11
Please list the other areas you are comfortable mentoring and advising on:
12
Are you interested in also being a subject matter expert (SME) to help other individuals (other than your assigned mentee)?* This field is required.
YESNO
13
What else would be helpful for us to know in order to match you with a small business owner?
14
In what city and state is your business located?* This field is required.City and state, please.
15
Name of your Business/Company* This field is required.
16
What product(s) and/or services(s) does your business/company offer?* This field is required.
17
What was your revenue in the last 12 months?* This field is required.Choose the range that best represents the total number of dollars your business brought in during the last 12 months.
$0-5,000
$5,000-$50,000
$50,000-$100,000
$100,000-$250,000
$250,000+
18
How long have you been in business?* This field is required.
Less than 6 months
6–12 months
12–24 months
24+ months
19
For the following five questions, please check off the areas you would like help from mentoring. If you do not need help in a given area, simply click "skip."
20
Accounting & Finance* This field is required.
Business Accounting / Budgeting
Cash Flow Management
Finance/Valuation
Tax Planning
Skip
21
Sales & Marketing* This field is required.
Customer Acquisition / Relations
Market Research / Competitive Analysis
Consumer Software
E-commerce
Skip
22
Operations & Execution* This field is required.
Technology & Computers
Product Supply
Crises Management/Recovery
Human Capital Management
Skip
23
Legal & Governance* This field is required.
Incorporation
Crises Litigation
Government Contracting
International Trade
Skip
24
Leadership & Management* This field is required.
Business Strategy
Communication
Conflict Management
High-Performing Teams
Skip
25
Are there any other topics not listed above that are a priority for you to receive Mentoring help?
26
What else would be helpful for us to know in order to match you with a Mentor?
27
Thank you! We are reviewing your application and will reach out soon.
28
Image Field
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For the following five questions, please check off the areas you would like help from mentoring. If you do not need help in a given area, simply click "skip."

Thank you! We are reviewing your application and will reach out soon.