Name:
Company name:
Address:
City/State/Zip:
Telephones:
office- ( )
cell- ( )
home- ( )
Email:
Web site: http://www.
Born on:
Ethnic background:
Organization type: __Sole proprietor __Co-op
__Partnership a Corporation __ LLC __Other/Unknown
Business type:
__ Retail __ Service __Wholesale
__ Manufacturing __ Construction __Agriculture
__Other
Business description:
Located in urban core: ___Yes ___No
Business Status:___ Start-up ___Expansion
___Pre-venture
___ Attended pre-venture seminar (where/when):
Previous entrepreneurial or business experience:
Describe your growth goals for the company:
Describe the market potential for your company:
Describe why you would benefit from a coach:
Other entrepreneurial training completed:
Referred by:
I am requesting to be a mentee for Mentor Coaching . I understand that with this agreement , I will be expected to attend regular meetings with my coach as well as pursue developmental opportunities as identified by my coach. I agree to cooperate, should I be selected to participate, in surveys designed to evaluate the effectiveness of my coaching. I authorize the sharing of relevant information to my coach, although I expect this information to be kept strictly confidential.
I further understand that coaches have agreed not to recommend goods or services from sources in which he/she has an interest, unless it is fully disclosed. I understand that there may be fees involved for developmental activities during the course of this coaching. In consideration of the management or technical assistance provided through this coaching, I waive all claims against The 3S Group – Creative Designs & Business Solutions personnel arising from this assistance.
Signature:__________________________
Date:_______________________________