Executive Mentor Intake

Step 1: Your Information

First Name *

Last Name *

Phone *

Email *

Step 2: Quick Profile

LinkedIn URL

Gender Identity *

Woman
Man
Non-binary
Prefer to self-describe
Prefer not to say
No elements found. Consider changing the search query.
List is empty.

Pronouns *

She/Her
He/Him
They/Them
Self-describe
Prefer not to say
No elements found. Consider changing the search query.
List is empty.

Self-Describe Pronouns

Race/Ethnicity *

Black / African American

Hispanic / Latino

Asian / Pacific Islander

White

Native American / Indigenous

Middle Eastern / North African

Multiracial

Other / Self-Describe

Prefer not to say

Are You a Member of any LGBTQI+ Community? *

Yes

No

LGBTQI+ Communities

Short Bio

Headshot Upload

Step 3: Professional Basics

Years Experience

Industry Experience

Advertising & Marketing
Aerospace & Defense
Agriculture & Farming
Automotive
Biotechnology & Life Sciences
Construction & Real Estate
Consulting & Professional Services
Consumer Goods & Retail
Education & Training
Energy & Utilities
Entertainment, Media & Sports
Financial Services & Banking
Government & Public Sector
Healthcare & Pharmaceuticals
Hospitality & Travel
Information Technology & Software
Insurance
Legal Services
Logistics, Supply Chain & Transportation
Manufacturing & Industrial
Nonprofit & Social Impact
Private Equity & Venture Capital
Real Estate Development & Property Management
Telecommunications
Other / Self-Describe
No elements found. Consider changing the search query.
List is empty.

Occupation/Role

State

City

Step 4: Preferences

Mentor Communication Channels

Email
SMS
Zoom
In person
Slack
Other
No elements found. Consider changing the search query.
List is empty.

Mentor Start Availability Date

Mentor Meeting Windows

Weekdays – Morning (8am–12pm)

Weekdays – Afternoon (12pm–5pm)

Weekdays – Evening (5pm–9pm)

Weekends – Morning (8am–12pm)

Weekends – Afternoon (12pm–5pm)

Weekends – Evening (5pm–9pm)

Mentors Preferred Cadence

Weekly
Biweekly
Monthly
No elements found. Consider changing the search query.
List is empty.

Mentor's Methods Of Meeting

In-Person
Virtual
Both
No elements found. Consider changing the search query.
List is empty.

Step 5: Confirm & Submit

Mentor Photo Release Consent

Yes

No

Mentor NDA Willing

Yes

No

I agree to BW Empowerment’s Mentor Program Guidelines and consent to receive program-related communications (reminders, confirmations, resources, and occasional updates). Message & data rates may apply. Frequency may vary. Reply HELP for help or STOP to opt out at any time.”

Privacy Policy | Terms of Service