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