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* 1. This survey asks for privileged and confidential information so that we can pair you with a mentor and/or mentee with similar experiences. By completing this survey, you understand that the members of the Mentorship Subcommittee of the Disability Rights and Issues Committee of the State Bar of Texas will have access to your answers. Although it is unlikely, there is a possibility that information you include in this survey can be intercepted and read by other parties besides members of the subcommittee.

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* 2. Name (First and Last)

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* 3. Email Address (This will be shared with your mentor/mentee)

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* 4. Job Title

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* 5. Does the gender of your mentor matter?

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* 6. What disabilities do you have experience, with and what relevant experiences have you faced as a result of a disability of either yours or a family members?

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* 7. For mentees: please describe the experiences you are seeking mentorship on (i.e. courtroom accommodation, technology accommodation, workplace accommodation).

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* 8. For mentees: do you want a mentor with certain experience? If so, what is that experience? (i.e. I want to be paired with someone who is also Deaf, I want to be paired with someone who has experience asking for accommodations in the office)?

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* 9. For mentors: if you are interested in being a mentor, what experiences can you mentor another person on (i.e. getting courtroom accommodations, asking for workplace accommodations, brainstorming technology accommodations)?

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* 10. How do you want to be paired?

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