Your Name:

Your Title:

Your Library:

Phone Number:

Email Address:

Are there special insights or experiences you want to bring to your mentoring relationship?

How much time will you commit to being a mentor:

One meeting followed by regular phone calls

Regular meetings

Irregular meetings

Other (please describe)

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

Yes    No

How important is physical distance from your mentee?

Not important        Somewhat important        Very important

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