Application

Mentor Registration

We have launched our Veterans Across America "Champion Mentors" initiative because we believe it is the single most powerful program we can deploy to arm unemployed and under-employed veterans with the tools they need to compete for quality employment, or start businesses. Our Champion Mentors initiative is an integral part of our "Six Months to Success" veterans' employment plan, which uses business mentors, education programs and employment conferences/boot camps to jump start veteran employment. Our founding principle is simple. We are asking each one of our Champion Mentors to team-up, one-on-one, with an unemployed or under-employed mentee, with a special focus on veterans who are wounded, disabled or homeless. We are asking our champion mentors not to provide a job to the mentees they work with, but to put their personal "networks" at the disposal of the veteran mentees, so that the veteran job-seekers or entrepreneurs can follow smart "networking" leads and find their own paths to success. By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

Fields marked ^* are mandatory.

First Name:	^*
Last Name:	^*
Personal Email Address:	^*
Best Contact Number:	^*
	^*
Best Time To Call:	^*
Employment Status:	^*
If retired please select:
If employed,select:
Company Name:	^*
Title:	^*
Department:	^*
Reports to:	^*
Work Phone:	^*
Work Address 1:	^*
Work Address 2:
Work Country:	^*
Work State/Province:	^*
Work City:	^*
Work Postal Code:	^*
Work E-Mail:	^*
What is your primary advocational interest (favorite hobby)?
How many hours a week are you willing to work with your mentee?
How far are you willing to travel to meet with your mentee?
Preferred Gender of Mentee:
What industries do you have work experience or professional knowledge in that you could share with your Mentee?	Administrative / Office Management Banking / Credit Biotechnology / Pharmaceuticals Business Development / Strategic Alliances Construction Management Custodial Customer Service / Client Relationship Management Education Engineering Events Management Facilities / Real Estate Management Finance / Accounting Financial Management Further Training Government Graphic Design Healthcare Hospitality / Travel Human Resources / OD Information Technology / MIS Insurance International Internet Security Legal / Law Logistics & Distribution Maintenance Management Consulting Manufacturing Marketing Non-Profit Operating Executives Project Management Public Relations / Marketing Communications Quality Assurance / Research & Development Regulatory Affairs Retail Management Retirement Sabbatical Sales / Sales Management Self Employment Technical Project / Program Management Unknown Web Development Writing / Editing ^*
Do you have experience in self-employment in additional to standard employment at a company? Choose BOTH if so.	Employment at a company Self-Employment ^*
Are you a Veteran?:	^*
What branches of the military are you familiar with, or which branches would you like to learn more about from your Mentee? Please select all that apply.	Army Army Reserves Army National Guard Navy Navy Reserves Airforce Air National Guard Airforce Reserves Marines Marine Reserves Coast Guard ^*
Years of Military Service?:
Final Military Rank?:
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