Mentee Intake Form

HERTZ COMMUNITY

Mentee Intake Form

The purpose of this form is to collect information from prospective mentees in the Hertz Community Mentoring program. Please be aware that information shared here will be available to all prospective mentors – please do not share confidential information. If you have any questions, please reach out to aleza@hertzfoundation.org.

About You

Name(Required)

Full Name

Email(Required)

Event Details

What kind of gathering are you planning?(Required)

For example, a coffee meetup, rooftop happy hour, new Fellow welcome brunch, or science salon.

When will the event take place?(Required)

The exact date is great, but “early September” or “sometime this winter” works too if you don’t know yet.

Where will the event take place?(Required)

City, venue if known, or let us know if it’ll be online.

What's the purpose of the event?(Required)

Consider how it will help connect or strengthen the Hertz community. For example, welcome new Fellows, build connections within the community, rally around a topic, partner with another group, or build local momentum for the campaign.

Guest List

Who would you like to invite?(Required)

For example, all local community members, just Fellows, 2025 Fellows, local Fellows who are in a specific field, or Hertz Fellows connected with a specific partner organization.

Should we encourage guests (plus ones, partners, kids)?(Required)

Yes

Not sure

How can we support you?

Check all that apply(Required)

Promote my event through the Hertz website and newsletter

Send me the regional email list (I’ll sign a quick confidentiality form first)

Add me to the Hertz Fellows-only listserv so I can share the event more broadly

Help with messaging or light logistics (copywriting, tips, etc.)

Funding

Requested amount?(Required)

Typically up to ~$40 per person for a typical, casual event.

What will funds be used for?(Required)

For example, food, drinks, space rental, or supplies.

Anything else?

Please let us know if there any additional details you'd like us to know.

Please let us know if there any additional details you’d like us to know.