Mentor Application Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
What's your industry background?* This field is required.Please select the industry or industries you have experience in from the options below.
Autonomy
AR/VR
Artificial Intelligence/Machine Learning
Cybersecurity
Internet of Things
Logistics
Mobility
Robotics
Telecom
Other
4
And what's your professional background?* This field is required.Please select the area or areas that best describe your professional experience.
Business Development/Sales
Business Operations
Finance
Hardware
Marketing
Product Design
Start-up Fundraising
Software
Other
5
What is your current role at the organization you work for?* This field is required.Example: Managing Partner, CFO, Business Developer, founder, etc.
6
Name for the organization you work for* This field is required.Example: Google, Intel, Facebook, MARL Accelerator, etc.
7
Which of the following sectors most interests you?* This field is required.Please choose the sector that you are most passionate about or interested in.
Early Stage Investment (Angel Investor, Fund Limited Partner)
DeepTech/Cyber Security
FinTech/Blockchain
IoT/Edge Computing
AgTech
EdTech
Technology Infrastructure
Other
8
How would you rate yourself on your ability to build and lead a team?* This field is required.Please rate the following from 1 (Very Poor), 2 (Poor), 3 (Average), 4 (Good), to 5 (Excellent)
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2
3
4
5
Very Poor
Excellent
9
How would you rate yourself on your ability to stay positive under pressure?* This field is required.Please rate the following from 1 (Very Poor), 2 (Poor), 3 (Average), 4 (Good), to 5 (Excellent)
1
2
3
4
5
Very Poor
Excellent
10
How would you rate yourself on your ability to proactively reach out and help others?* This field is required.Please rate the following from 1 (Very Poor), 2 (Poor), 3 (Average), 4 (Good), to 5 (Excellent)
1
2
3
4
5
Very Poor
Excellent
11
How would you rate yourself on your ability to come up with creative solutions?* This field is required.Please rate the following from 1 (Very Poor), 2 (Poor), 3 (Average), 4 (Good), to 5 (Excellent)
1
2
3
4
5
Very Poor
Excellent
12
How would you rate yourself on your ability to get things done fast?* This field is required.Please rate the following from 1 (Very Poor), 2 (Poor), 3 (Average), 4 (Good), to 5 (Excellent)
1
2
3
4
5
Very Poor
Excellent
13
How many hours per month can you commit to mentoring startups?* This field is required.Please specify the number of hours you can dedicate each month.
Huge
Large
Normal
Small
Ok
Ok
14
How many mentoring sessions can you conduct per year?* This field is required.Please specify the number of sessions you are willing to conduct annually.
Huge
Large
Normal
Small
Ok
Ok
15
What previous experience, if any, do you have in mentoring others?* This field is required.Please give as much detail as you can about previous duties and roles.
Huge
Large
Normal
Small
Ok
Ok
16
Are you willing to make quality introductions to corporate partners or investors?* This field is required.Please indicate if you are prepared to provide 10-15 quality introductions per year.
YESNO
17
Do you give us consent to send you informational and some marketing email?* This field is required.
I acceptI don’t accept
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