Please fill out the application below.

If you need to save your application and complete at a later time, you can click the “Save for Later” tab at bottom of the page. You will need to submit your email address and setup a password in order to retrieve your application later. Please save your password as you will not be able to retrieve the information without it. If you need to go back and complete your saved application, simply click on the “Continue Saved Form” tab at the bottom of the page. You will have to enter your email address and password to continue your saved form.

If you have any questions or problems, please contact Jan Wehrman at 210.486.5904 or email

Mentor Application

Legal Business Name/d.b.a

Business Address

Mailing Address

Web Address

Business Phone

Date Business Established and State of Formation or Incorporation

Owner Name and Title

Form of Business [corporation, partnership, etc.]

E-mail Address

Number of Full-time employees

Number of Part-time employees

SCTRCA Certification Status

In the last three (3) years, I have bid on City jobs as a

In the last three (3) years, I have been awarded City jobs as a

Disclaimer
Participation in the City of San Antonio’s Mentor Protégé Program is not a guarantee of contracting opportunities; nor is it a promise of business, but rather it is a means to foster positive long-term capacity building skills for small, minority and women-owned businesses. The assistance provided by the Mentor Protégé Program affiliates is to improve upon business practices and offers no guarantee of financial gain.

***Signature mandatory ***

Firm Representative (printed first and last name)

Signature of firm representative*:

Title:

Date:

*Signature certifies the firm representative identified is authorized to make decisions on behalf of the firm and agrees to attend all portions of this Program, without substitution. Signature also certifies that information on all corresponding pages and attachments is true and accurate. In addition, signature certifies Mentors and Protégés meet the qualifications listed in the Bonding Assistance & Mentor-Protégé Program Guide.

Applicant Assessment

Mentor applicants : Check the areas of expertise in which you wish to provide assistance:

1. Provide a brief company summary, including company profile, general and specialized operational areas of expertise, historical and recent activities and accomplishments in support of S/M/WBEs, operating history, any prior Mentor/Protégé relationship, etc.

2. Describe how the company will provide the necessary time and resources to ensure a successful Mentor/Protégé relationship. If lacking a presence in the San Antonio Metropolitan Statistical Area (SAMSA), please list the communication channels to be used in meeting with a protégé if and when assigned one.

Applicant Assessment

Check your areas of expertise

Other areas of expertise

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