American Bar Association Judicial Division
Judicial Mentoring Program

Judicial Mentor Questionnaire

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Personal Information
Title:
Name:
Business Address:
City:
State/Province:
Zip/Postal Code:
Country:
E-mail Address:
Telephone Number:
Fax Number:

Optional Alternate information for secretary or law clerk
Name:
E-mail Address:
Telephone Number:
Fax Number:
Attorneys participating in the program will be matched with mentors by gender, ethnicity, disability and sexual orientation to the extent possible and desired. Identifying yourself in these categories will assist in the matching process.
Gender:
Sexual Orientation (optional):
Race/Ethnicity:
Disability(optional):

American Bar Association Section or Division ABA ID#
American Judges Association
Hispanic National Bar Association
Judges Advocate General (specify branch)
National Asian Pacific American Bar Association
National Association of Administrative Law Judges
National Association of Women Judges
National Bar Association
National Native American Bar Association
National Lesbian and Gay Law Association
Other

Are there any particular limitations with regards to your participation in this program?
How many lawyers are you willing to mentor?
How did you hear about this program?

If you have any questions regarding this form or the program, please contact Judge Leslie Miller at lmiller@sc.pima.gov.

Agreement Statement I agree that all the above information is accurate to my knowledge and that I am solely agreeing to be matched up with attorneys based on the information I provided above to participate in the Judicial Division Judicial Mentor Program. Enter today's Date (mm/dd/yyyy): Your information will only be used within the ABA and its entities. We do not sell or rent e-mail addresses to anyone outside the ABA. The Judicial Division Mentor Program is cosponsored by the ABA Young Lawyers Division.