Mentor Match Program:

MENTOR Application

Thank you for your interest in being a Mentor for out Mentor Match Program! Please complete this application to help us get to know you and your business, as well as how to contact you. 


Please complete the form below

Name *
Phone *
Date Established *
Date Established
Business Address *
Business Address
I understand that by completing this application, I am agreeing to the terms of the Mentor Match program facilitated by the Women’s Small Business Accelerator, Inc. I also understand that the WSBA does not perform any tasks on behalf of or for program attendees. As a volunteer and program attendee you take responsibility for completing the program to the best of your ability and give only the advice and feedback that you believe will benefit your Mentee. You further understand that the Mentee agrees to take full responsibility and assumes all liability for the implementation of any advice or feedback given by you. Completion and submission of the application is merely a request for entrance into the Mentor Match program, and not a guarantee of acceptance, as participation in the program is based on availability of a Mentor to match a specific Mentee’s needs. Information provided in this form helps the WSBA understand the audience we address and will be kept strictly confidential within WSBA and its partner organizations and evaluators. Additional terms: • All participants, including Mentors and Mentees, and all volunteers will be required to sign a non- disclosure/confidentiality agreement. • All participants, including Mentors and Mentees, and volunteers will be required to give the WSBA permission to use their name, company name and a professional photo in any WSBA media release, marketing material, and on the WSBA website for the purpose of promoting WSBA and its programs. However, no proprietary information will be used. By completing this application, you are giving the WSBA permission to use the information described above. • Mentors are required to complete an orientation program before being matched with a Mentee. This program will cover the expectations of being a Mentor, how to work with Mentees, and working with the WSBA.
Mentor Match Program Fees
from 100.00

By completing this form it confirms your permission for the Women’s Small Business Accelerator to charge your credit card a $100 non-refundable application fee and a $500 program fee at the start of your participation in the Mentor Match Program. If you have any questions, please call us at 614-414-2449 or email us at

Mentor Match Payments:
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