Mentor Expression of Interest Form
A Mentor is a successful prime consultant or contractor with the capability to mentor small businesses in capacity building in order to successfully bid for City Contracts.
Section 1: Background Information
Business Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
*
-
Area Code
Phone Number
Website
Contact Person
*
First Name
Last Name
Contact Person Phone
*
-
Area Code
Phone Number
Contact Person Title
Contact Person E-Mail
*
LBE Certification Number (If Applicable)
Please Answer the following questions:
1. Have you enclosed a cover letter describing why your company should be included in the Mentor/Protege Program?
Yes
No
Cover Letter
Cover Letter Upload
2. Have you participated in any mentoring program(s) before?
Yes
No
3. If you are a Small Business Mentor, have you been certified as an LBE?
Yes
No
If yes, are you currently certified by any certification agency other than CMD?
Yes
No
Please indicate certifications below:
DBE
SBE
DVBE
MBE
SBA(8a)
Other
Section 2: Professional Reference
Reference #1
Reference Name
First Name
Last Name
Firm Name
E-mail
Phone Number
-
Area Code
Phone Number
Client/Owner
Reference #2
Reference Name
First Name
Last Name
Firm Name
E-mail
Phone Number
-
Area Code
Phone Number
Client/Owner
Reference #3
Reference Name
First Name
Last Name
Firm Name
E-mail
Phone Number
-
Area Code
Phone Number
Client/Owner
Section 3: Firm/Company Goals
What are your Firm's goals?
Enhancing the growth potential and developing capacity of Proteges.
Yes
Providing opportunities to give back to the community through knowledge transfer.
Yes
Providing Proteges with networking and outreach opportunites and strategies.
Yes
Cultivating business relationships to foster new opportunities for Protege firms.
Yes
Providing education on any or all of the five Capacity Building Strategies in Section 4 below.
Yes
Encouraging non-certified firms in San Francisco to obtain LBE and other certifications.
Yes
Working with Proteges to achieve graduate status within one year of entering the Program.
Yes
Section 4: Capacity Building Strategies:
Please check all categories in which you are willing to mentor:
Organizational/Structural Needs.
Yes
Leadership Development Needs.
Yes
Financial/Business Infrastructure Needs.
Yes
Insurance/Bonding Needs.
Yes
Networking/Business Community Engagement Needs
Yes
Submit
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