Mentoring Emerald Coast Mentee Application Form 2023- 2024

Vision Statement:
Mentoring Emerald Coast is world-class in connecting experience with potential.

The Mentoring Emerald Coast Program prides itself on being extremely beneficial to you whether you are engaged as a Mentor, a Mentee, or Sponsor.

Registration Fee: $350
Registration Fee for Walton Area Chamber Members: $250

Please submit applications by September 4, 2023, at 12 p.m.

Contact Gabby Kilgore-Woods with any questions at 850.892.3191 or e-mail gabrielle@waltonareachamber.com.

Please enter the information indicated below.

First Name *

Last Name *

Title: *

Business Name: *

Type of Business: *

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Business Phone: *

Cell Phone: *

E-mail Address: *

Business Website:

Please list your community involvements, professional associations, and personal interests. *

Please list your three (3) greatest accomplishments (professional, social, or otherwise) achieved in the last 5 years. *

What is the biggest challenge you currently face in your job? *

What are your top three (3) strengths? *

What are your top three (3) weaknesses? *

Have you ever been mentored before in a structured mentoring environment or do you have a mentor now? What was your experience in that program? *

Why are you interested in being a mentee? What does a successful mentoring experience mean to you? *

The minimum commitment to the mentoring program requires your attendance at a training meeting, graduation banquet, and 10-12 meetings with your mentor. As a way to ensure the quality of this mentoring program, you will be expected to report the occurrence and scheduling of your meetings with your mentor. Your mentor and you may agree to a larger time commitment. Please list how you will make this commitment. *

What are your career aspirations? *

How do you best learn? (e.g., reading an article or book, by observing others, through coaching or feedback, by role playing, etc.) *

What specific goal(s) do you have for your mentoring process? Please list. *

Please indicate whether the following areas are a strength, an area you may need help with, or not applicable. This information will be one component considered in matching you with a business mentor. *

	Strength	Weakness	Not Applicable
Marketing & Advertising	Strength	Weakness	Not Applicable

Accounting/Finance	Strength	Weakness	Not Applicable

Talent Management	Strength	Weakness	Not Applicable

Business Planning	Strength	Weakness	Not Applicable

Inventory Management	Strength	Weakness	Not Applicable

Organizational Design	Strength	Weakness	Not Applicable

Customer Relations	Strength	Weakness	Not Applicable

Staff Relations	Strength	Weakness	Not Applicable

Operations & Production	Strength	Weakness	Not Applicable

Management/Leadership	Strength	Weakness	Not Applicable

Business Growth/Sales	Strength	Weakness	Not Applicable

Strategic Planning	Strength	Weakness	Not Applicable

Product Development	Strength	Weakness	Not Applicable

Quality Control	Strength	Weakness	Not Applicable

Peer Relations	Strength	Weakness	Not Applicable

Team Building	Strength	Weakness	Not Applicable

Please indicate all locations acceptable for meeting with your mentor: *

Destin Freeport Niceville DeFuniak Springs Ft. Walton Beach Santa Rosa Beach All locations Other location (not listed)

I authorize the verification of all statements contained herein and the references listed above to give you any personal or otherwise and release all parties from all liability for any damage that may result from furnishing same to you. *

Yes No

Signature (please type your name): *

Date: *

Please upload your resume/bio and photo (if available).

Mentoring Emerald Coast Mentee Application Form 2023- 2024

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