Contact | Centrepolis Accelerator

Select a form to fill out.

First Name *

Last Name *

Busness Name *

Your Title *

Business Address Line 1 *

Business Address Line 2

City *

State *

Zip Code *

Country *

Email *

Phone

Website

Have you mentored with other organizations? If yes, please list here:

What is your area of functional specialty? (Check all that apply) * Manufacturing Engineering Business Strategy Finance Marketing Sales

Provide details on your expertise in each area: *

Please list the last three (3) businesses (minimum of three) you were associated with along with job titles: *

Which answer best matches your experience working with start-up companies: *

Which answer best matches your experience working with small to medium sized manufacturers: *

How many hours per month are you available to mentor?

What days/times work best for you to mentor?

Our clients are located throughout SE Michigan; how far are you willing to travel to mentor?

Please provide a copy of your CV/resume: