Application

I am applying to become a *

Mentor

Mentee

Would you like to receive info on how to get your employer involved with CSweetener?

Yes

No

Name *

First Name

Last Name

Mobile Phone

Country

(###)

###

####

Office Phone

Country

(###)

###

####

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Role

Do you hold a role within 3 levels of the c-suite or topmost position(s) in your organization? If no, please offer additional information describing the structure of your organization and your role in it, and why you believe you should be offered CSweetener mentorship.

Yes

No

Startup Founder

Are you the founder of a startup with less than 3 years in operation and $3M in annual revenues?

Yes

No

Mentor: *

Have you founded or served on the original executive team of a startup that is publicly traded/was acquired/is otherwise mature, and would like to mentor startup founders?

Yes

No

I Identify as

The following optional section of the application collects demographic information to help improve CSweetener programs and services, and will only be used for that purpose. CSweetener does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations.

I prefer to self-describe

Race/Ethnicity

(Check all that apply)

Black or African American

Hispanic/Latino

Middle Eastern or North African

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

White

Sexual Orientation

(Check all that apply)

Heterosexual

Gay

Lesbian

Bisexual/Pansexual/Asexual

Additional Identification

(Check all that apply)

Transgender

Older worker (age 50+)

Returning worker (returning after extended leave)

I am a person with a disability that qualifies under the Americans with Disabilities Act