Email: I prefer to be contacted by: Phone Email
Information in this section will be used to create an individual mentee profile that will be used to pair you with a mentor. Information may also be used for statistical and evaluative purposes.
Undergraduate school: Year of Graduation:
Law School: Year of Graduation:
Bar Related Activities:
Hobbies & Interests:
Additional Relevant Information:
Why are you interested in participating in the program?
Please select three areas which best describe your practice:
Admin/governmental Intellectual Property
Antitrust Litigation International
Bankruptcy Practice Management
Business/Commercial Personal Injury/Property Damage
Elder Real Estate/Landlord Tenant
Employment/Labor Law Social Security
Family/Domestic Tort and Insurance
Federal Practice Taxation
General Practice Traffic
General Litigation Trial Work
Health Workers Comp.
Check those which apply to your employment:
Type of Practice: Size of firm:
Solo Practice 1 Lawyer
Of Counsel 2‐9 Lawyers
Law Firm 10‐39 Lawyers
Government office/Judge 40+ Lawyers
I prefer a mentor who practices in areas:
__ Similar to my own ___ Different (please list below):
I prefer a mentor who is:
__ male ___ female age range: ___________
Please like any additional information you would like us to consider in selecting a mentor for you: ________________________________________________________
A. I do hereby certify that I meet all of the following minimum qualifications:
Active Status. I am an active member of the Milwaukee Bar Association; and,
Disciplinary Action. I have never received the sanction of disbarment or suspension from the practice of law in any jurisdiction, nor have I voluntarily surrendered my license to practice law for the purpose of disposing with a pending disciplinary proceeding in any jurisdiction. I am in good standing with the Office of Lawyer Regulation.
B. I have read and understand the Rules and Regulations of the MBA’s mentoring program
You may return this form via email or postal mail:
Milwaukee Bar Association
Attn: Mentoring Program
424 E. Wells St.
Milwaukee, WI 53202