SCALE: Mentee Application

ChicagoMSDC SCALE (Supplier Capacity & Leadership Engagement) Mentorship Program
Program Term: Six-month cohort cycle
Purpose: This application is used to determine MBE eligibility, growth readiness, capacity, and alignment for participation as a SCALE Mentee.
Instructions: Please complete all sections. ChicagoMSDC may request additional
documentation, conduct an interview, and a Needs Assessment before approving participation. Submission of this application does not guarantee selection, mentor matching, or a contract opportunity.
Section 1: Mentee Form Information
Legal Business Name
Doing Business As (if applicable)
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website
Primary NAICS/Industry
Number of Employees
Annual Gross Revenue

Other
What Year was the Company Founded?
NMSDC Certification Status

Other
Section 2: President or CEO Applicant Information
President or CEO Name

First NameLast Name
Title
Email
example@example.com
Mobile #
Please enter a valid phone number.Format: (000) 000-0000.
Years with the firm
Primary Role in Growth Strategy
Section 3: Eligibility Confirmation
Please confirm that your firm meets the following mentor eligibility criteria:
Section 4: Business Profile and Growth Readiness
Briefly describe your firm’s core products or services, target customers, and current market position.
What are your primary growth goals for the next 6–12 months?
Describe your current capacity to pursue, win, and fulfill corporate contracts.
Section 5: Needs Assessment Focus Areas
Select the areas where your firm would benefit most from mentoring, technical assistance, or structured support:

Other
Section 6: Financial and Operational Information
Most Recent Annual Revenue
Prior Year Annual Revenue
Current Number of Full-Time Employees
Current Number of Part-Time Employees
Corporate Contracts Secured in Last 12 Months
Bid or RFP Submissions in Last 12 Months
Capital Accessed in Last 12 Months, if applicable
Please list the financial documents you are prepared to share confidentially with ChicagoMSDC for assessment purposes.
Please confirm your firm will participate in matching opportunities and conduct due diligence on potential Mentor before final match approval.
Please explain:
Section 7: Matching Preferences and Due Diligence
What type of Mentor firm would be most helpful to your growth goals?
Please disclose any current or potential conflicts of interest with prospective Mentor firms, including ownership, family, employment, financial, subcontracting, or competitive relationships.
Section 8: Program Fee Acknowledgment
Please acknowledge the applicable program fee based on your annual gross revenue level:
Section 9: Program Commitments
By applying to participate as a SCALE Mentee, the applicant agrees to the following commitments if selected:
Section 10: Development Plan Readiness
What measurable outcomes do you hope to achieve during the six-month program cycle?

Other
Please describe the milestones you believe would indicate meaningful progress for your firm during the program.
Section 11: Required Attestations
I certify that the information provided in this application is true and complete to the best of my knowledge.
I certify that my firm is in good standing with the State of Illinois and ChicagoMSDC.
I certify that my firm is not debarred or suspended.
I understand that ChicagoMSDC may verify eligibility, conduct interviews, and request supporting documentation.
I agree to share financial and operational information confidentially for program assessment and measurement purposes.
I understand that final Mentee approval and Mentor matching are subject to ChicagoMSDC review and approval.
I understand that participation does not guarantee a contract opportunity.
Section 12: Submission Checklist
Please ensure you have completed all of the following
Section 13: Required Uploads
Capability Statement or Company Overview

Cancelof
Bio or Resume

Cancelof
Applicant Certification and Signature
President or CEO Name

First NameLast Name
Title
Date

MonthDayYear
Date
By signing below, I certify that I am authorized to submit this application on behalf of the mentor firm and that the information provided is accurate and complete.
Should be Empty:

Section 1: Mentee Form Information

Section 2: President or CEO Applicant Information

Section 3: Eligibility Confirmation

Section 4: Business Profile and Growth Readiness

Section 5: Needs Assessment Focus Areas

Section 6: Financial and Operational Information

Section 7: Matching Preferences and Due Diligence

Section 8: Program Fee Acknowledgment

Section 9: Program Commitments

Section 10: Development Plan Readiness

Section 11: Required Attestations

Section 12: Submission Checklist

Section 13: Required Uploads

Applicant Certification and Signature