Mentor Application

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FOR ECBA MEMBERS ONLY

Name

Email

Telephone

Address

City, State, Zipcode

PLEASE SELECT ONE:

I would like to RECEIVE Mentoring Assistance I would like to PROVIDE Mentoring Assistance

FOR RECIPIENTS:

Date admitted to the Massachusetts bar?

In what area of law would you like to receive mentoring assistance?

FOR PROVIDERS:

In which type of setting do you practice?

Private Small Firm (1-6 lawyers) Large Firm Corporate In-House Counsel Government

Please indicate your total years in practice:

Less than 1 year 1 to 3 years 3-5 years More than 5 years

Please indicate specific areas of the law in which you have experience and would like to mentor:

LEGAL MALPRACTICE INSURANCE INFORMATION

Name of Insurer:

Limits per person:

Aggregate:

Effective Dates:

Policy Number:

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