purposes the recruitment, administration, and marketing of the Catalyze Klamath Falls Challenge

1 Page

MENTOR VOLUNTEER FORM

Date of Application

Select the type of mentorship you would like to provide

Oregon Tech will match each mentor as closely as possible with a specific individual team based on the mentor’s expertise and the student’s major, interests, and goals.

Mentor for an individual team: A paring of individual team with a mentor, where the students ask a set of questions or areas in which she/he is seeking advice and mentoring support

Catalyze Mentor Speaker: A willingness to share your time, skills, and knowledge with the Catalyze Klamath Falls Challenge teams as a guest speaker.

Industry Partnership Mentor: Companies that would like to have a relationship with Oregon Tech to support the Catalyze Klamath Falls Challenge and/or future innovation and entrepreneurship projects.

Financial Mentor (DONATION): Funding is dedicated to expanding the quality of the Catalyze Klamath Falls Challenge mentoring program.

Workshop Mentor on expertise area: Conduct a workshop for Catalyze Klamath Falls Challenge teams that focuses on business plans, raising capital, intellectual property or other relevant topics. Please explain the type of workshop you are willing to offer.

Contact Information Mentor Name

Company Name & Address

City, State, Zip

Phone Cell

E-Mail

Company Website

Igniting Entrepreneurship of Students and Recent Alumni of Oregon Tech Catalyze Klamath Falls Challenge aims to support business ideas and/or fledgling entrepreneurial activity from any field of study that produces a new idea, product or service that could become a thriving business in Klamath Falls, and has the potential for job growth in rural Oregon.

Visit our website: www.oit.edu/catalyze

2 Page Mentor Professional Category

Allied Health Communication

Engineering Management

Other

Years of experience in the selected category

What do you hope to contribute by participating in the mentoring program?

What specific points/skills or industry expertise can you provide to student teams?

Have you had any other previous experience in mentoring students?

No Yes Please describe

Have you participated in the Catalyze Mentoring program in the past?

As a Mentor In what Year?

Student

Sponsor Mentor Objectives

Signature Date:

I hereby give CONSENT to the use and disclosure of the information contained in my application for the

purposes the recruitment, administration, and marketing of the Catalyze Klamath Falls Challenge

Mentoring Program at Oregon Tech.