MENTORING PROGRAM

PROTÉGÉ APPLICATION FORM
Please print form, fill it out and mail to the address below

 

NAME _______________________________________________________________________________
                                        First                                          Middle                             Last

HOME ADDRESS ______________________________________________________________________

_____________________________________________________________________________________
       City                                         State                       Zip Code                                Home Phone

PLACE OF EMPLOYMENT _______________________________________________________________
(IF APPLICABLE, INCLUDING PART-TIME)

ADDRESS _____________________________________________________________________________

City_________________Zip Code__________________Work Phone_______________________________

E-MAIL _______________________________________________________________________________

I AM:

 

Male

 

Female

I AM A:

 

Latino Spectrum Scholar

 

REFORMA Scholarship Recipient

 

Librarian.  Please specify the type of library:  _____________________________________________________

EDUCATION:  

    _______            Undergraduate [B.A.] Year of Graduation

    _______            MLS Year of Graduation                    

    _______            Anticipated MLS date of Graduation

MLS INSTITUTION _______________________________________________________________________

Please list any professional special interests (public service, technical services, technology, etc),
areas of expertise, and leisure interests you could share with a mentor:

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

What aspects of the library and information field are you interested in? ___________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

LANGUAGES:     

     Speak                _________________________________________________________

     Read                  _________________________________________________________

   Understand        _________________________________________________________

                               

Reasons why I would like to have a REFORMA mentor (check all that apply):

 

Positive role model.

 

Objective feedback on my career aspirations.

 

Access to informal library networking possibilities.

 

Assistance in "learning the ropes" to be effective and successful.

 

Being exposed to professional associations, groups, and meetings.

 

A source of information on my future occupational/professional goals in library and information management,
which are:

 

 

Other (please specify)

 

 

REFORMA CHAPTER

 If you belong to a REFORMA Chapter, please list the name of the Chapter

 ___________________________________________________________________________________________

COMMITMENT

I understand that to be involved in the REFORMA Mentoring Program I will have to commit to the following:

 

Signed ______________________________________________________________________
                                                                         (Applicant)

Please return application or direct inquiries to:

Alberto Herrera
Raynor Memorial Libraries
Marquette University
1355 W. Wisconsin Ave.
P.O. Box 3141
Milwaukee, WI  53201-3141
Tel: (414) 288-2140
Fax (414) 288-8821
email alberto.herrera@marquette.edu

 

 

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