Mentor Application - Thrive Scholars

Save my progress and resume later | Resume a previously saved form

Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Your Email:

A Password:

Confirm Password:

Volunteers who complete this form will be contacted by a staff member when our Mentor Application opens in March of 2022.

Please contact us via this link if you have any questions about this form. Thank you!

Personal Information

First Name	Last Name
Date of Birth (mm/dd/yyyy)	Preferred Email Address We recommend using your personal address that you check most frequently.

Mobile Number

Opt into text notifications or reminders

YesNo

Mailing Address

City

State

Zip Code

Gender	Other
Pronouns	Race & Ethnicity (Select one or more) American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinxNative Hawaiian or Other Pacific IslanderWhite

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?

YesNoSelect "Yes" if you did not have a parent or guardian who graduated with a bachelor's degree.

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 contact information 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 encourages that 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 a Scholar and that I must communicate updates with staff during the course of our relationship.

Save my progress and resume later | Resume a previously saved form

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 Inquiry

General Information

Mentor Profile Questionnaire

Mentor Profile Questionnaire