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MENTOR APPLICATION

I am interested in serving as an RIEI UMKC Mentor. I can commit hours per month (minimum 6).

I would like to know more about the program first, please contact me for a discussion.


Full Name *

 

Title *

 

Business Name *

 

E-mail Address *

 

Cell Phone *

 

Work/Home Phone *

 

Preferred Mailing Address *

 

City *

 

State *

 

Zip *

 

My Industry Expertise (check all that apply):

Health Care

Real Estate

Consumer Products

Media/Entertainment

Information Technology

Petroleum/Energy

Financial Services

Services

Telecommunications/Wireless

Artesian

Not for profit

Retail

Other

 

My Functional Expertise (check all that apply):

Start-Up

Angel Investment

Franchising

Venture Capitalist

Marketing/ Sales

Information Systems

Finance/Accounting

Operations/Production

Legal

Strategy/Planning

Branding/Communications

Digital Marketing/Database Management

Other

 

NON-INVESTMENT AGREEMENT/CLAUSE

The UMKC Regnier Institute for Entrepreneurship and Innovation E-Scholars program is supported by interaction and exchange of knowledge by mentors to E-Scholars in a safe environment where the mentors have a fiduciary standard of compliance which is in the best interest of the E-Scholars. I do hereby acknowledge, agree, and covenant to abide by the following terms and conditions:

1) I will recuse myself from the mentor program if I should decide to invest in an E-Scholar enterprise prior to graduation or completion of the E-Scholar program.

2) I will not actively nor passively provide any capital investment, intellectual property, consulting for compensation or any other type of assistance to an E-Scholar venture where I have a financial gain.

3) I will not have any person or persons act on my behalf to provide any capital investment, intellectual property, consulting for compensation mentoring assistance or any other type of assistance to the venture as long as the E-Scholar is in the program and up until graduation.

4) In the event I elect to become an investor in any E-Scholar enterprise while I am a mentor or in any other the E-Scholars Program affiliated with UMKC venture, I will notify Regnier Institute leadership in writing of the change from mentor to investor;

* Please type your initials as an agreement to the above RIEI Mentor Commitment statement.