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About the LM Programs
Apply to the LM Program
Print a Brochure
View Course Descriptions
Forms for Students
Forms for Mentors
View Mentor/Student Teacher Handbook
School Library Media Endorsement
and Library Media Minor

 

 

 

MENTOR REQUEST FORM

Please note that all field must be filled in prior to clicking on the Submit button or you will receive an error message. Thank you.

Are you requesting a mentor for the first time, or are you requesting to change your mentor? First time Change my mentor

Student Contact Information

Date: in mm/dd/yyyy format, ex. 02/14/2009
First Name: Last Name:

Address:

    
City: State: Zip Code:
Country:    
Home Phone: Work Phone:
Preferred Email Address:    

Student Employment Status

Are you currently working in a school? 

Yes

 No

If you are employed in a school, are you employed 

Full time Part time

What type of position do you hold?

  

What level is your current position?

  

Name of School:

Name of District:
What type of libraries are you primarily interested in? Elementary Middle Secondary