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Ms Moxxie Mentee Application

The 2020 Ms Moxxie program will begin the second week of May and run thru December.  We will be accepting mentee applications in January 2020. Feel free to email us with any questions at info@moxxiementoring.org.

Note that if your application is approved, payment must be made prior to the start of the program.

Personal Info

First Name:*
Last Name:*
Home Address:*
Home City:*
Home State:*
Home ZIP Code:*
Mobile Phone:*
Date of Birth:*

Professional Info

Company Name:*
Company Address:*
Company City:*
Company State:*
Company ZIP Code:*
Company Position:*
Company Phone:*
Company Email:*

Group Meetings

Meetings take place from 8:00 - 9:30 AM. Year 1 groups meet once every three weeks from May through December. Meeting locations are in Nassau, Suffolk and Mid-Island. Which location is most convenient to your home or work?

NOTE: - We may be adding an evening group in Melville. Please check if you prefer this.

Your Goals

What are you hoping to learn from Ms Moxxie?

How did you hear about Ms Moxxie?

Program Fee - $695.00

NOTE - Fee must be remitted BEFORE the beginning of the program in May.

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