*
Required
Prefix
*
required
First Name
*
required
Last Name
*
required
Suffix
Class Year
*
required
Did you submit all your clearances and serve as a LEAP Mentor last year? (Clearances are valid for 5 years)*
Yes
No
PA State, Child Abuse & FBI clearances are now required to be a LEAP Mentor. Are you able to obtain your clearances by November 1, 2023? *HGP will provide necessary links and reimburse all costs.*
Yes
No
I was a mentor last year and my business information is the same.*
If there are no changes to your business information, please select yes to use the information you submitted last year.
Yes
No
Number of Students You Can Mentor
*
required
Please Select…
I can mentor 1 student.
I can mentor 2 students.
Willing to discuss this further.
Company Name
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required
Company Location (city/state)
*
required
Business Title
*
required
Business Industry
*
required
Business Category
*
required
Please Select…
Arts & Music
Computers
Engineering
English
Languages
Mathematics
Science
Social Science/Government
Law/Law Enforcement
Preferred Email
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required
Business Phone
Cell Phone
Professional Bio
*
required
Company Logo
Max file size: 10 MB
Please also include my information in the public HGP Alumni Business Directory.
My information is already included in the HGP Alumni Business Directory.
I do not wish to be included in the HGP Alumni Business Directory at this time.
Please send a confirmation email to the address below*: