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Mentor Interest Form

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Thank you for your interest in being a Mentor with The MEBI.  Please fill out the brief interest form below.  We will be reviewing all of the interest forms over the next several weeks and will be in touch with next steps in the coming weeks.

If you have questions please feel free to reach out to us at

Upon completion of this interest form you will be given access to our online community powered by Startup Space. Please log in and complete your profile. Our virtual hub will provide you with added access to local events, local connectivity and more. Please look for your temporary password once you click submit.

Do you identify as any of the following “Communities of Interest”? (Choose all that apply).*This question is not used to qualify participants, but instead used to help us validate that we are inclusive of people of all kinds. Thank you for your response.
Is there a particular interest in which you prefer to provide mentoring?*Select up to three that apply
Is there a particular industry in which you prefer to provide mentoring?*Select up to three that apply
All information exchanged and provided between parties shall remain strictly confidential. This includes anything written, verbal, visual or inferred. Confidentiality remains in place even after the conclusion of the program or mentor/mentee relationship.*
Each Participant will hold full responsibility for all decisions related to their plans, products or services. Furthermore, the benefits gained from participating in this mentorship program are a result of time, energy and dedication of the individuals involved, and thus are not based on participation in the program alone.*
The advice that Mentors and Facilitators have given is each person’s own and not that of Startup Space and their affiliate programs. Each Mentor and Facilitator is responsible for the information and opinions that he or she has given to Participants. Mentors and Facilitators may address legal, accounting, or other professional issues, but users should not treat these responses as legal, accounting, or professional advice. Such advice can only be properly given by qualified professionals engaged by the Participant. Mentors, Facilitators and Participants acknowledge that they have read this Letter of Understanding and accept the terms as written.*

Please complete all required fields before submitting the survey.

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