Mentorship Program Registration Form by JamiePeacock


									                                                                          Mentorship Program
                                                                          Registration Form
                                            Mentor Application

Membership number                                    Company

Prefix                                               Size of workplace

First name                                           Address 1

Last name                                            Address 2

Suffix                                               City                        Postal

Email                                                Phone Number
Language(s)           English
spoken                                               Pre-law area(s) of
                                                     Law school

Preferred language                                   Year of call

Are you willing to                                   Hometown
accept an
out-of-town mentee?       No

Which areas of law do you currently practice
and in what areas do you have experience?

Describe yourself, including information
such as extra-curricular interests and
affiliations, family, etc. Also list past
mentoring experience, if any.

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What criteria are important for you in the
matching process? Consider whether you
are in a position to best assist a male or
female mentee, whether you can relate to
any cultural/ethnic background or sexual
orientation, a mentee with a disability (if so
please describe), whether you have
experience in the public or private sector,
large or small firm, general service or
boutique firm, small town, etc.

What do you hope to gain from the
mentoring program?

                               Submit by Email         Print Form

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