WN Mentorship Program Form | Mentor 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.

Mentor Information:

Mentor Name: *

First Name *

Last Name *

Title *

Please type your job title.

Company *

Please type the name of the company you work for.

Email Address *

Please type the best email address to reach you at.

LinkedIn Profile

Contact Preference *

Please select which form of communication you would prefer. This is how your mentee will contact you to connect!

Phone Number *

Please enter the best phone number to reach you at.

Please add your headshot for the database:

20MB max

Mentorship Structure Preference

Highly Structured - Would like to be personally connected to mentee, 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 mentee atleast once a month.

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

Highly Structured

Loosely Structured

Mentor Professional Experience:

Mentor(s) Biography/Experience *

Expertise *

Communication

Negotiation/Conflict Resolution

Goal Setting

Leadership

Organization/Time Management

Program Agreement:

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 Greater Wyoming Valley Chamber Women's Network and the Amplify past graduates and present classes.

I agree

Digital Signature *

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

First Name *

Last Name *

Digital Signature Date *

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

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