Have an account? Click here to log in...

Mentor Smart

Mentor Application

Please complete the following form in order to be evaluated for the program and matched with an appropriate Mentee.

Permissions

May we use your name, bio & photo publicly (on our webpage, PRs, etc?) *

Yes
No
Please reach out to me to discuss

Please upload your photo

Clicking below will open a new tab on your browser to upload your photo in your account profile in our system.

Once done, please return to this tab to finish the application.

Upload Your Photo

The Basics

First Name *

Last Name *

Email *

Preferred Phone # *

Company Name *

Job Title *

Your Preferences

How many teams would you like to mentor? *

One (1)
Two (2)

With what stage(s) of companies are you willing to work (select all that apply)? *

Concept (no product/may have a plan)
Pre-startup (prototype/alpha or beta/may have a plan)
Startup (some revenue/early adopters)
Emerging Growth (revenues up to $2M)

Your Strengths

Industry (Choose up to 2): *

Big Data
Computer Hardware
Computer Software
EdTech
Energy / CleanTech
FinTech
Interactive Entertainment / Games
IoT (Internet of Things)
Internet / eCommerce
Life Sciences / Healthcare
Medical Devices
Mobile Apps
Retail / Consumer
Robotics
Virtual Reality
Other

If OTHER, please specify industry sector:

Domain expertise (Choose 3) *

Electronics: Computers & Networks
Electronics:Consumer Electronics:Devices
Electronics:Robotics
Defense
Digital: e-Commerce
Digital: Games & Entertainment
Digital: Media & Publishing
Digital: MobileIT & Networking
Digital: Software & SaaS
Education
Energy & Cleantech
Life Sciences - Systems & IT
Life Sciences - Medical Devices
Life Sciences - Pharma MEMS
Operations & Manufacturing
Retail (bricks & mortar)
Semiconductor
Services: Financial
Services: Graphics & Web Design
Services: Legal
Social & Nonprofit
Transportation (air-rail-auto)

Functional Expertise *

Engineering & Product Development
Finance (Accounting, etc)
Fundiing (VC, Angel, etc)
Graphic Design
CMS Website Dev
Human Resources
IT
Legal
Leadership
Operations & Manufacturing
Marketing
Market Research
Sales
Business & Channel Development
Other

If OTHER, please specify

Your Experience

Please provide us with your professional bio *

Tell us about any mentoring experience (when/ with what organization)*

Anything else we should know?

Standards of Behavior

I have read and agree to the standards of behavior set forth by this program.

No
Yes