2025 YPN Executive Mentorship Application ~ Mentor

Thank you for applying to the 2025 YPN Executive Mentorship Program. Please use this form to apply as a mentor.

The application deadline is Friday, November 1, 2024. The Capital Region Chamber recognizes the value to learning and growth that comes with having a diverse and inclusive program. We strive to increase the diversity of participants including: age, race, color, national and ethnic origin, religion, gender, gender identity and/or expression, sexual orientation, military or veteran status, marital status, disability, socio-economic status and work experience. Our goal is to create a program that is representative of the diversity in our region.

Fields marked with an * are required.

First Name *

Last Name *

My preferred name or common name is: *

My preferred pronouns are, and my gender identity is: *

Organization *

Employer's Address *

Please include street address, city, state and zip

Work phone *

E-mail address *

Title *

Years of Experience in your field *

Age *

22-25

26-30

31-35

36-40

41-45

46+

How long have you lived in the Capital Region? *

Would you like to be matched with someone in your field? *

Have you participated in a mentoring program before? *

How did you hear about the program? *

Colleague

Friend

Email from Capital Region Young Professionals Network

Employer

Chamber e-newsletter

Other

If you selected other, please specify

What are your hobbies or personal interests? *

Which of the following is your preferred method of communication? Check all that you prefer. *

In person

Phone

Zoom/Teams

What is the best time to contact you? *

Do you have a flexible schedule? *

Please share any time constraints

Please note

Your responses to the questions below will remain confidential.
This information will NOT be shared with the person that you're matched with.

What do you hope to gain by participating as a Mentor? *

Can you support these professional development objectives? Check all that apply

Skill development/enhancement

Professional networking/resources

Promotion/job change support

Career transition

Other

If you selected other, please specify

What are two goals you want to accomplish by supporting a mentee? *

If you selected other, please specify

What are your areas of interest. Check all that apply *

Career Development

Leadership

Management

Networking

Work life balance

Other

If you selected other, please specify

Where do you draw inspiration from?

Please share authors, public speakers, public servants, artist etc. that you have found to be inspirational to your personal/professional development.

Any addition information about you, that you would like to share?

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