Mentor Application - Thrive Scholars

Personal Information

First Name	Last Name
Date of Birth (mm/dd/yyyy)	Preferred Email Address

Mobile Number

Opt into text notifications or reminders

YesNo

Home Address

City

State

Zip Code

General Information

Are you currently employed?

YesNo

Employment Information

Company Name

Industry

Work Phone Number

Work Street Address

City

State

Zip Code

Position Title

Position Level

Education

What college/university did you graduate from (if your school is not listed, select "Other")?

If "Other", name of college:

What was your Major/Minor?

Were you a first generation college student?

YesNo

Do you have an advanced degree?

YesNoCurrently Enrolled

Graduate University or Program:

Graduate Degree Attained/Major:

Mentor Profile Questionnaire

Mentee Preferences

Gender Preference of Mentee

Do you have any other preferences regarding a potential mentee?

How else would you like to get involved?

Are you interested in participating in a webinar, panel discussion, or other speaking engagement to share professional or academic expertise with our Scholars? If so, please indicate any preferred formats and topics here.

References

Please list the names and telephone numbers of two professional or personal references and describe their relationship to you:

First Reference

Name:

Relationship:

Email:

Phone Number:

Second Reference

Name:

Relationship:

Email:

Phone Number:

Clearance Information

Have you ever been convicted of a felony or misdemeanor

YesNo

Please share details about the conviction, including charge and date.

Mentorship Program Requirements

I would like to apply for:

Please read and initial the statements below:

I understand that Strive Mentorship requires a one (1) year commitment and monthly communication with a Scholar.

I understand that Strive Mentorship requires I meet with my Scholar in-person at least twice a year, unless conducting remote mentorship.

I understand that Launch Mentorship offers varied cycles, which each have a minimum commitment and communication requirements.

I understand that I will be required to complete the Mentor Training prior to working with my Scholar and communicate with staff during the course of our relationship.

Gender	Other:
Pronouns:	Are you Hispanic or Latinx?
Please indicate how you identify yourself. (Select one or more) WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific Islander	If applicable, please indicate how you identify. (Optional) WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific Islander

Agriculture	Apparel	Architecture
Banking	Biotechnology	Business
Chemicals	Civil Engineering	Communications
Construction	Consulting	Education
Electronics	Energy	Engineering
Entertainment	Environmental	Finance
Food & Beverage	Government	Healthcare
Hospitality	Individual/Household	Insurance
Law	Machinery	Manufacturing
Marketing	Media	Nonprofit
Other	Pharmaceuticals	Public Affairs/Policy
Real Estate	Recreation	Religious
Retail	Shipping	Technology
Telecommunications	Transportation	Utilities
Visual/Performing Arts	Venture Capital / Private Equity

Thrive Scholars Mentor Application

Personal Information

General Information

Mentor Profile Questionnaire

Mentor Profile Questionnaire