CII Startup Mentor Enrollment Form

1. Prefix *

First Name *

Last Name *

2. Designation *

3. Organisation *

4. Phone *

5. Email *

6. City *

7. Language Proficiency *

8. What Sector would you be interested in mentoring *

9. Out of the following which stage of companies would be most relevant to you *

10. Please list your area of expertise *

11. Why do you want to mentor? *

12. How much time can you spend for Mentoring *

1-2 hrs per week

2-4 hrs per week

4-6 hrs per week

13. Your strengths as a Mentor *

14. Upload your photo

15. Upload your brief profile / CV