Calgary Black Chambers Mentor Form
Thank you for getting this far along the process. We require all of our Mentors to complete the following form in order to pair them with prospective Mentees and gain a sense of where they are in terms of Mentorship capabilities.

Important to this process is honesty and truthfulness. Please complete the form as accurately as possible.

After you submit, one of our members will be in touch about next steps.
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First Name *
Last Name *
Contact Email *
Gender pronouns *
How do you identify racially? *
How old are you? *
Contact Phone Number *
Your industry of experience *
Required
Company *
Position / Role *
Please provide your social media handle for the following platforms: Twitter, Facebook, LinkedIn, Instagram. (Utilized for verification purposes) *
Please select your highest level of education achieved *
Current Professional Status *
Do you have prior experience working with young adults? (e.g. coaching, teaching, volunteer) *
If yes, please describe
Why do you want to be a mentor? *
What unique qualities and characteristics do you bring to the program? (Point form) *
How good are you at listening actively? *
Poor
Excellent
Can you build trust with people? *
Poor
Excellent
Are you good at encouraging? *
Poor
Excellent
Can you help people set goals? *
Poor
Excellent
Can you help people gain new capabilities? *
Poor
Excellent
Do you have the ability to inspire others? *
Poor
Excellent
Can you give constructive feedback? *
Poor
Excellent
How's your ability to identify and deal with risk? *
Poor
Excellent
How would you rate your ability to create opportunities for your mentee? *
Poor
Excellent
I am comfortable mentoring students/young professionals pursuing *
Required
In which area would you most like to mentor someone? *
Required
How many mentees can you take on? (1 = 4 hours/month, 2 = 8 hours a month) *
I attest that this form has been filled out in good faith as accurately as possible. *
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