Mentoring Sign-Up

SILS MENTORING SIGN-UP FORM

Name:
	I am a (check one) Mentor Student

MENTORS: PLEASE COMPLETE THE FOLLOWING:
Title:
Organization:
Degree Received:
School:
Year of Graduation:
Briefly describe your main areas of responsibility:
Would you be willing to mentor more than one student? Yes No

IF YOU'RE A STUDENT, PLEASE COMPLETE THE FOLLOWING:
Anticipated Degree:	MSLS MSIS BSIS Undergrad Major Undergrad Minor PhD
Anticipated Year of Graduation:
Are you currently working?	Yes No
If yes, please describe where you work, your department, and what your responsibilites are:

Briefly describe the type of work you think you'll be interested in the future (this information is to assist in mentor matching):

Do you have access to transportation for an off-campus or out-of-town placement? Yes No

EVERYONE, PLEASE COMPLETE THE FOLLOWING:
Address:
City:
State:	Zip:
Telephone:
E-Mail:


(Questions: E-mail the Alumni Board.)