LES Mentoring Form

I would like to be a *

mentor.

mentee.

Contact Information

Name *

Address

Phone

E-mail *

Please contact me using my

mailing address.

phone number.

E-mail address.

I work in a *

university library.

college library.

other:

other

Other areas of responsibility:

I am responsible for the following subjects/academic departments: *

Mentors, please indicate your level of experience in the following areas. ("5" being most experienced)

Mentees, please indicate your level of interest in receiving mentoring in the following areas. ("5" being most interested)

	(None)	1	2	3	4	5
reference *	reference - (None)	reference - 1	reference - 2	reference - 3	reference - 4	reference - 5
instruction *	instruction - (None)	instruction - 1	instruction - 2	instruction - 3	instruction - 4	instruction - 5
conference attendance *	conference attendance - (None)	conference attendance - 1	conference attendance - 2	conference attendance - 3	conference attendance - 4	conference attendance - 5
collection management *	collection management - (None)	collection management - 1	collection management - 2	collection management - 3	collection management - 4	collection management - 5
administration/supervising *	administration/supervising - (None)	administration/supervising - 1	administration/supervising - 2	administration/supervising - 3	administration/supervising - 4	administration/supervising - 5
library association committee service *	library association committee service - (None)	library association committee service - 1	library association committee service - 2	library association committee service - 3	library association committee service - 4	library association committee service - 5
faculty liaison *	faculty liaison - (None)	faculty liaison - 1	faculty liaison - 2	faculty liaison - 3	faculty liaison - 4	faculty liaison - 5
conference presentations *	conference presentations - (None)	conference presentations - 1	conference presentations - 2	conference presentations - 3	conference presentations - 4	conference presentations - 5
poster sessions *	poster sessions - (None)	poster sessions - 1	poster sessions - 2	poster sessions - 3	poster sessions - 4	poster sessions - 5
publishing *	publishing - (None)	publishing - 1	publishing - 2	publishing - 3	publishing - 4	publishing - 5

interest grid *

Is there anything else we should know about your experience or goals that might help us match you with the best mentor/mentee?

Subject expertise? Expectations of this program?

Leave this field blank