Startup Grind Mentor Application

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First Name *

Last Name *

Location (City, State, Country) *

Phone Number

Email Address *

Linkedin Profile link?

Angelist Profile link?

Other Personal Links?

Highest Educational Background:

School/University/Technical School

Personal Summary

Why are you interested in becoming a Startup Grind Mentor? (brief summary) *

What are some of your TOP ACHIEVEMENTS you would like your mentees to know?

What DOMAIN EXPERTISE do you have? *

Have you formally mentored before (f.g. MBA class, Startup Weekend, Accelerator, Incubator, etc)?

Yes

Clear selection

If yes, which one?

Which kind of startup can you help THE MOST? *

How many HOURS can you can dedicate PER startup a month? (F.G. 1 hour per startup per month)

How many startups are you able to mentor per month?

How would you like to interact with your mentees (Please check all that applies)?

In Person

Online (Skype, Google Hangouts)

Over the Phone

What QUALITIES do you look for in a mentee?

Have you INVESTED in a startup before?

Yes

Clear selection

If you could RECOMMEND ONE BOOK for your mentee to read, what would it be?

Background References

(please include at least one family member, one personal friend and one work reference):

Reference #1 Full Name

Reference #1 LinkedIn or Angelist Profile:

Reference #1 Email

Reference #1 Relationship:

Within the past 10 years, have you been convicted of any felony or misdemeanor classified as an offense against a person or family, or an offense of public indecency or a violation involving a state/federally controlled substance? *

Yes

Required

Are you under current indictment or has a district/county attorney accepted an official complaint for any of the offenses in question #5? *

Yes

Required

If the answer is YES to questions 5 or 6, please explain below:

Acknowledgement

I understand that the mentor program involves spending a MINIMUM OF ONE (1) HOUR EVERY MONTH for EACH STARTUP online or in person. (Maximum: 7 startups each month) *

Yes, I understand

Required

I understand that I will be required to complete the mentor program orientation and at least TWO TRAINING sessions during the year.

Yes, I understand

In making this application to be a volunteer, I understand that Startup Grind Mentor routinely performs criminal and driving record checks of all volunteers for the position of mentor for which I am applying. This check may be done on me if I sign below. If I fail to sign, it may be grounds for rejecting me as a mentor. I certify to the best of my ability that the information provided on this application is true and accurate. I also understand that misinformation knowingly provided here, and on subsequent mentor application forms, is grounds for dismissal.

Yes, I understand and accept these terms.

Signature (FULL NAME)

Date Signed

YYYY

Submit

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