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Mentor Application
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Applicant Name*:
Address
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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?*
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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?
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“Thank you for your interest in becoming a mentor. We will get back to you shortly.”
We typically reply within 2-3 business days. If you have not heard from us in that timeframe, please contact us at 619.823.8658.