MENTOR REQUEST FORM

PERSONAL INFORMATION First Name Last Name Contact Telephone Number/s: (With Country and City Code) Contact e-mail Address Based in (city) Educational background (degree, university) Year of graduation Current Occupation MORE INFORMATION ABOUT YOUR IDEA/VENTURE In broad terms please describe your business idea /opportunity (250 Words) Business /Technology Sector (e.g. IT/BPO/Retail/Hospitality /Education/Internet/alternate energy/healthcare/consumer goods/consumer services/financial services) What consumer pain point is your product/service addressing? Name of the company Year it was founded

EXPECTATIONS: Please share your expectations with us to enable us to help you in the best possible manner

Revised on Dec 8, 2009 with help from Amit Grover, Mumbai Angels

What are your expectations of this mentoring session? What help/guidance are you looking for in particular? Please describe in about 200 words any specific question you may have Have you requested and/or received Mentoring before

Revised on Dec 8, 2009 with help from Amit Grover, Mumbai Angels