Medical Library Association | MLA Mentoring : Add Record to the Mentor Database

* Your MLA ID#:

* First Name:

* Last Name:

* Email address:

* Daytime telephone:

Daytime fax:

Institution:

Library:

* City:

* State or Province:
(U.S. or Canada only)

* Country:

* MLA chapter area:

Choose up to five areas of expertise from the topics at left (lists are repeated):

* Are you a member of the Academy of Health Information Professionals?

Yes No
If yes, what level?

In which of the following mentor capacities would you be willing to serve?
(please check all that apply):

Mentor to provisional members of the academy (visit the academy mentor site for a list of requirements and responsibilities)
Mentor to new members of MLA or the profession
Mentor to those interested in changing their career to medical librarianship
Speaker about medical librarianship at career fairs, conferences, or high schools
Mentor or host to library school students for half-day or full-day visit to a medical library
Mentor to a colleague seeking my expertise
Other mentoring opportunity (please describe your idea below)

* How would you prefer to be contacted by a prospective mentee? (please only check ONE):

telephone
email

* To help us combat fraud, please enter the characters you see in the box at the right:

Become an MLA Mentor

**Individual Information (Required items are marked with a * )**

Education: Degrees

Granting Institution, City, State/Province

Expertise

Mentoring Preferences