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1. Registration Form

Welcome to the SUNY Buffalo Law School Mentor Program! Thank you for your willingness to participate. Please take a few moments to answer the questions below as this information helps us significantly 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 we have the most recent information available to us.

Please mark your calendars for our "Mentor Matching Reception" on Wednesday, March 4, 2015 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 Lisa Mueller, Assistant Dean for Alumni and Communications at 716-645-3176 or lmueller@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 particularly like to be matched with a mentee with any of the following characteristics? 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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