2025 Access Mentorship Program ApplicationAccess Mentorship Program – Protégé ApplicationName* First Last Employer*Job Title*Email*Phone*Are you currently an Access member?* YES NOHow did you hear about the Access Mentorship Program?*What other organizations or committees do you currently belong to?*What do you look to gain from participating in this program?*What do you look for in a mentor, either personally or professionally?*We cannot guarantee that you will be matched with your top picks, but please indicate your first and second choice mentors below.First Choice Mentor* Terrie Ard (The Moore Agency) Philip Browning (Synchros) Rob Clarke (Ausley McMullen) Tom Derzypolski (BowStern Communications) Eddie Gonzalez Loumiet (Ruvos) Scott Higginbotham (Prime Meridian Bank) Dan McGrew (TSG Advisors) Ana Melendez (A&E Wholesale) Chris Mills (Truist) Gloria Pugh (AMWAT Moving Warehousing Storage) Cari Thro (Tallahassee Democrat/Tallahassee Media Group) Becky Tolnay (Vistage) Denise Wilson (Capital City Bank)Second Choice Mentor* Terrie Ard (The Moore Agency) Philip Browning (Synchros) Rob Clarke (Ausley McMullen) Tom Derzypolski (BowStern Communications) Eddie Gonzalez Loumiet (Ruvos) Scott Higginbotham (Prime Meridian Bank) Dan McGrew (TSG Advisors) Ana Melendez (A&E Wholesale) Chris Mills (Truist) Gloria Pugh (AMWAT Moving Warehousing Storage) Cari Thro (Tallahassee Democrat/Tallahassee Media Group) Becky Tolnay (Vistage) Denise Wilson (Capital City Bank)Do you prefer to be matched with someone in your industry?* Yes, same industry No, a different industry No preferenceProvide any conflicts of interest we should consider when pairing you with a mentor.Optional DemographicsAge21-2526-3031-3535-4040+GenderFemaleMalePrefer Not to AnswerRace/Ethnicity (check all that apply)CaucasianHispanicLatinoBlack or African AmericanAsianPacific IslanderNative American or American IndianOtherAcceptance of TermsBy applying you are agreeing to meet with your mentor twice a month March 2025 through May 2025. It will be your responsibility as the protégé to schedule meetings with your mentor. I also understand that I may not be paired with a mentor this cycle.* Yes, I agree