CRT Mentor Application | Chairmen’s RoundTable

Thank you for your interest in becoming a CRT Mentor.

CRT requires mentors to meet very specific criteria. If you meet these criteria and are interested in becoming a mentor, we invite you to complete our online application below. Once we receive your information, our Vice Chair, Mentor Development will review it and contact you to discuss your application.

All fields marked by an * are required.

Applicant Name*:

Address

City

State

Zip Code

Phone*

Email*

Are you currently serving or have served within the recent past two years as chief executive officer of a qualified corporation or privately owned business?*

Yes No

List company, business sector, title and length of service:

Have you served as the general manager or president, with full P&L responsibility, of a company, major division or subsidiary of a corporation?

Yes No

List companies, market sectors, title and length of service and annual revenue of each company at time of exit:

Have you served a cumulative total of five years on Boards of Directors? (These must meet the standards of a qualified corporation or a substantial not-for-profit corporation.)

Yes No

List company, business sector, title and length of service:

Describe your community service activities, listing names of any organizations and board service:

List and prioritize business sector experience:

List and prioritize areas of executive expertise:

List three career accomplishments:

Why are you interested in becoming a mentor at CRT?

How did you learn about Chairmen's RoundTable?*

Have you ever attended a Chairmen's RoundTable meeting?

Yes No

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