For Graduates

2014-2015 Returning Mentor Registration Form

Please complete this form by August 29, 2014

By enrolling as a returning mentor you are agreeing to:

1.  Initiate contact with your student(s) at least twice a month.

2.  Meet with your student(s) at least once a month.

3.  Fill out an evaluation of the program mid-school year and at the end of the term.  

General Information
Last Name:
First Name:
Email Address:
Preferred Mailing Address:
Work Phone:
Home Phone:
Mentoring Options: Please select ONE of the following options
Continue with CURRENT/PRIOR ONLY Student Mentees(s) - (List the student(s) below and skip to step 5)
Continue with CURRENT/PRIOR Student(s) AND match with NEW Student(s) - (List the student(s) and complete steps 1 - 5)
Match with NEW STUDENT(S) ONLY (Complete steps 1 - 5)
NEW! Co-Mentor Student Mentee(s) with another attorney - (List name of other attorney below if known, otherwise we will match you)
I CANNOT mentor this year. - Skip to step 5. We hope you'll re-join the program in the future.
If you are continuing with current/prior student mentee(s), please list their name(s) here:
If you would like to co-mentor student mentee(s) with another attorney and know who you want to be paired with, enter their name here:
If you checked that we can match you with new students this year, how many are you willing to take?:
Match by gender:: Female student
Male student
No preference
Do you have any other preferences that we should take into consideration when matching you with a student or co-mentor?:
Mentor Background Information (Complete ONLY if you are taking a new student)
Employer/Firm Name:
Title/Position:
Practice Emphasis:
Type of Practice:Private Practice
Solo Practice
Government
Judicial
Academic
Public Interest
Corporate
Other
If you responded "Other", what type?
Years in Practice:
Your Age:
Your Gender:Male
Female
Family Status:Single
Single Parent
Married/Partnered (Without kids)
Married/Partnered (With kids)
What is your undergraduate, law school, other graduate school background?
Briefly describe your legal and professional experience:
Matching Questions (Complete ONLY if you are taking a new student)

The following information will help us match you with your student.  (Complete ONLY if you are taking a new student)

Outside interests/Personal background:
Which of the following do you feel you can offer a law student?Assistance in understanding the practice of law
Interviewing and hiring practice issues
Discussion of legal career alternatives
Advice about balancing career and family
Introductions to other members of the practicing Bar
Discussion of gay/lesbian/bisexual issues
Assistance in understanding law school
Other
If "Other", please describe:
Meeting Times and Student Contact
Best time of day and way for student to contact you:
Best days/time of day for you and your student to meet: We ask all mentors to commit to meeting with their student(s) at least 1-2 hours per month.
“Kick Off” Mentor/Student Reception

2014 Kick Off Reception.  Tuesday, Sept. 16th, 2014.  5:30-7:30pm.  Willamette University College of Law, Room 201. Please check in outside of Room 201.  We will help you and your mentee(s) find each other.   245 Winter ST SE Salem, OR 97301. 

This is an opportunity for you to meet your student and to begin becoming acquainted. The reception features a brief program, followed by hosted hors d’oeuvres and beverages.

(If attending, please mark your calendar for the Kick Off Reception.)

Will you attend the Kick Off Reception?Yes
No