Your Name:

Your Title:

Your Library:

Phone Number:

Email Address:

Are there special insights or experiences you hope to learn from your mentoring relationship?

How much time will you commit to being a mentee:

One meeting followed by regular phone calls

Regular meetings

Irregular meetings

Other (please describe)

Would you prefer to work with a mentor within your own library specialty?

Yes    No

How important is physical distance from your mentor?

Not important        Somewhat important        Very important

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