Ms Moxxie Mentee Application

DUE TO THE CORONA HEALTH SITUATION, WE HAVE POSTPONED THE START OF THIS PROGRAM UNTIL SEPTEMBER.  IT WILL ASLO START AS A VIRTUAL PROGRAM AND MAY BECOME IN-PERSON.

We are accepting mentee applications now. 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:*
Direct Supervisor Name:*
Direct Supervisor Title:*
Direct Supervisor Phone:*
Direct Supervisor Email:*

Group Meetings

Meetings take place from 8:00 - 9:30 AM. Year 1 groups meet once every three weeks from May through December. Which location is most convenient to your home or work?

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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