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Mentor/Coach Signup

Mentor/Coach Application

Mentors at ProGeny Place offer value to our network of founders through industry or personal knowledge or expertise, life experience and/or learnings, but also connections that could help our network of aspiring, first-time, or serial entrepreneurs. While there are different ways to give of your time through ProGeny Place programs, your commitment as a Coach or Mentor will provide value to entrepreneurs that is big, small, once, or ongoing.

1. First Name *This question is required.

2. Last Name *This question is required.

3. Email *This question is required. This question requires a valid email address.

4. Cell Phone Number *This question is required.

5. City *This question is required.

6. State/Region *This question is required.

7. How would you like to get involved?

8. Company/Organization

9. Entity Type: *This question is required.

10. Please select applicable industry:

11. Linkedin Profile:

12. Do you have any current or past affiliation with ProGeny Place? *This question is required.

13. Were you referred to be a mentor/coach by anyone? Please list their name, if so.

14. What do you feel are the strongest areas in which you could help as a mentor/coach? *This question is required.

15. What type of time time commitment are you able to make? *This question is required.

16. In three sentences or less, tell us why you want to mentor with ProGeny Place and what experience you have with mentoring (being mentored included.) *This question is required.

17. Building a more diverse coach/mentor pool to reflect the population of the entrepreneurs we serve is important to us. Please share the following demographic information with us.

What gender do you identify with? *This question is required.

18. Race & Ethnicity: Please select any and all race and ethnic categories with which you identify. *This question is required.

American Indian or Alaska Native
Asian
African American/Black
Hispanic/Latinx
Native Hawaiian/Other Pacific Islander
White
Prefer Not to Say
Other - Write In Please enter an 'other' value for this selection.

19. Are you a military veteran?