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1. Registration Form

Welcome to the University at Buffalo School of Law Mentor Program! Thank you for your willingness to participate. Please take a few moments to answer the questions below as this information helps us with the matching process. Even if you have completed a similar questionnaire in the past, we ask that you do so again this year to be sure that we have the most recent information available to us.

Please mark your calendars for our "Mentor Matching Reception" on Tuesday, February 28, 2017 from 6 to 8:00 p.m. at the Center for Tomorrow on UB's North Campus. The reception will provide you with the opportunity to meet your assigned student in person.

If you have any questions or concerns regarding the program, please contact Ilene Fleischmann, Executive Director of the UB Law Alumni Association at (716) 645-7347 or fleisch@buffalo.edu.

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* 1. Contact Info, please enter all pertinent information:

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* 2. Educational Information (enter any relevant information):

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* 3. In which practice sector do you currently work?

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* 4. In which of the following sectors have you worked in the past (check all that apply)?

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* 5. Please indicate your primary practice areas (check all that apply):

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* 6. Please list any other cities in which you have worked or lived:

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* 7. How many mentees are you willing to take this year? Up to:

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* 8. Would you like to be matched with a mentee with any of the following characteristics in particular? Mentees have been asked to identify similar matching criteria. Please check all that apply and provide specific information, if necessary, in the space provided below.

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* 9. Any other comments regarding the mentor program:

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* 10. May we release this information?

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