2021 YPN Executive Mentorship Application - Mentor

Thank you for applying to the 2021 YPN Executive Mentorship Program. Please use this form to apply as a mentor.

Application must be received by 5 p.m. on Friday, October 9. The Capital Region Chamber recognizes the value to learning and growth that comes with having a diverse and inclusive program. We strive to increase the diversity of participants including: age, race, color, national and ethnic origin, religion, gender, gender identity and/or expression, sexual orientation, military or veteran status, marital status, disability, socio-economic status and work experience. Our goal is to create a program that is representative of the diversity in our region.

Fields marked with an * are required.

First Name *

Last Name *

I identify my gender as: *

What are your preferred pronouns *

Organization *

Employer's Address *

Please include street address, city, state and zip

Work phone *

E-mail address *

Title *

Years of Experience in your field *

Age *

24-29

30-39

40-49

50+

How long have you lived in the Capital Region? *

Would you like to be matched with someone in your field? *

Have you participated in a mentoring program before? *

How did you hear about the program? *

Colleague

Friend

Email from Tech Valley Young Professionals Network

Employer

Chamber e-newsletter

Other

Comment

What are your hobbies or personal interests? *

Which of the following is your preferred method of communication? Check all that you prefer. *

Phone

Face-to-face

What is the best time to contact you? *

Do you have a flexible schedule? *

Please share any time constraints

Please note

Your responses to the questions below will remain confidential.
This information will NOT be shared with the person that you're matched with.

Why do you want to be a mentor? *

Comment

What are your areas of interest (check all that apply)? *

Leadership

Management

Career Development

Work/Life Balance

Networking

Other

Comment

Any additional information you would like to share?

Please verify that you have checked the “I'm not a robot” checkbox.