WN Mentorship Program Form | Mentee Application

We're looking for inspired women to join us as mentees and mentors for a new mentorship program that will elevate professionals in our area, presented by the Greater Wyoming Valley Chamber's Women's Network in partnership with Leadership Northeast! 

Please complete the form below to be included on a private database that will be shared with future members of the Amplify program as well as any woman who reaches out to the Greater Wyoming Valley Chamber's Women's Network for mentorship opportunities!


Fields marked with an * are required.

Please verify that you have checked the “I'm not a robot” checkbox.

Mentee Information:

Please type your job title.

Please type the name of the company you work for.

Please type the best email address to reach you at.

Please enter the best phone number to reach you at.

Highly Structured - Would like to be personally connected to mentor, will follow a structured program for one year and will use the Elevate WN Mentorship Handbook for every meeting. You will follow the discussion questions in the handbook and work to meet with mentor atleast once a month.

Loosely Structured - Would like to connect with the mentor on a more organic level, will check in with mentor once in a while, and will loosely take the Elevate WN Mentorship Handbook into consideration when meeting.

Highly Structured
Loosely Structured

Skills you would like to refine:

Skills you would like your mentor to be considered an expert at.

Communication
Negotiation/Conflict Resolution
Goal Setting
Leadership
Organization/Time Management
Mentorship Program Agreement

By selecting this option, you agree to let the Greater Wyoming Valley Chamber of Commerce share your submission and everything included within it to the mentors of the Greater Wyoming Valley Chamber Women's Network.

I agree

Please type your first and last name again in place of a signature.

Please select today's date to confirm your adherence to the agreement above.