PAM Division Mentoring Program Application Form

Name:____________________________________ 
Title:___________________________________     
Address:_________________________________     I want to be a   Mentor   Mentee
        _________________________________    (please circle:  you can be both)
City, State, ZIP:_____________________________       
Phone:_________________ Fax:__________________    
Email:________________________________________      

How much time do you expect to commit to the mentorship?_______________________
  ___________________________________________________________________
Do you have gender/ethnic/personal preferences for a mentor/mentee?____________
  ____________________________________________________________________

Preferred Area(s) of Expertise  (please circle all that apply)
  Subject Area:   Physics,  Astronomy,  Math,  Computer Science
  Library Type:  Corporate/Technical,  Academic,  Government,  Non-profit,  
                    Solo
  General:  Administration/Management, Bibliographic Instruction,   
            Collection Development, Reference, Systems/Automation, Job Seeking,
            Writing for Publication, SLA Involvement, Advancement/Promotion,   
            Conflict Resolution, Fundraising/Grantwriting,  
            Marketing/Public Relations, Cataloging

What do you want out of a mentorship? __________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
        ________________________________________________________________________
       _________________________________________________________________________
       _________________________________________________________________________

Describe your work/school experience in the library/information field.__________
        ________________________________________________________________________
        ________________________________________________________________________
       _________________________________________________________________________

Please send the Completed Form to:

         Karen Croneis
         Chair, PAM Division Mentoring Subcommittee
         Univ. of Alabama Libraries
         P.O. Box 870266
         Tuscaloosa, AL 35487-0266    USA