Thank you for your interest in the MENTOR Leadership program. Complete this form to begin your Social Entrepreneur Leadership Journey. The program has four tracks which include:

Business Entrepreneur (for-profit)
Business Philanthropy (hybrid)
Ultimate Philanthropy (non-profit)
MENTOR Certification (facilitator/coach)

You must select one track to begin your journey. Take a moment to review the required Membership Plans and Program Sequence options on the lefthand side of the form. Then, complete the form below and tell us a little bit about yourself and your business.

Notice to Student Applicant

Fill in all required form fields. If a field does not apply to you. Then type the letters NA.
By completing this form, your rights, as a member, are protected under the Family Education Rights and Privacy Act (FERPA). To learn more visit, the U.S. Department of Education FERPA website.
Members under 18 years old must have their parent complete and sign the Parental Admission Form before admission will be granted.

Currently, we can admit new members continuously throughout the year on a first come first served basis. To learn more, review our Open Enrollment Policy.

It should take approximately 4-5 minutes to complete.

MENTOR Enrollment Application

Name *

Enter first name

Last *

Enter last name

Business Name *

Enter business name

Website

Enter website URL

Phone *

Enter phone number

Email *

Enter email address

Are you a member of a Chamber of Commerce *

Select an option

If yes to adjacent question, which Chamber and City?

Enter a response, if applicable

What is your ethnicity? *

Select an ethnic group

Are you between the ages of...? *

Select an age range

Which MENTOR program track are you enrolling? *

Select a program track

Which Mentor Chamber Center do you prefer? *

Select a mentor chamber center to call home

Which Membership Plan will you subscribe to as a program participant? *

Select a membership plan

Which program sequence are you most interested in completing? *

Select a program phase.

What is your business purpose or mission? Provide a brief description of your business in sufficient detail. *

Tell us more about your business or project

What stage of development is your business? *

Select a developmental stage

What project will you work on in the program? *

Select a project (Note: IP stands for intellectual property)

How did you hear about the Mentor Leadership program? *

If Other selected above

Please enter the name of the referring agency, partner, or company.

By clicking the submit button below, I acknowledge and understand that Oracles of Truth Academy or another affiliate partner (collectively, “OTA”) may use all or a portion of the statements provided in this enrollment form to assess my personal lifestyle and business needs in order to determine what services that I might be eligible to receive or participate. I also understand that OTA may, at its discretion, fix minor spelling and grammatical issues from any of the statements I provide in this entry form. In addition, I acknowledge and understand that OTA may contact me at the email address and/or phone number provided on this enrollment form. *

I acknoweldge and understand the terms.

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