Mentor Program Application - Florida Agricultural & Mechanical University

Florida A&M University, College of Law Mentoring Program

The FAMU College of Law Mentoring Program pairs mentors and mentees for an entire academic year and is designed to provide law students with guidance in all aspects of the practice of law.

NameFull Name

Phone

MENTOR PARTICIPANT REQUIREMENTS

Mentor Requirementsplease indicate that you meet these requirements

I am an attorney or judge licensed to practice law with a minimum of 10 years’ experience in my fieldI am in good standing with my State BarI have no pending complaints or disciplinary actions with my State BarI have no 10-year disciplinary history with my State Bar

Bar AdmissionsState or District

Bar No.If applicable

Employer

The following information will be used by the Mentoring Program Committee to match you with a mentor or mentee.

Mentors: Please state your top three primary practice areas.

Please provide any other information that you would like the Mentoring Program Committee to consider when matching you with a mentor/mentee.You may attach additional pages if necessary.

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By checking the boxes and signing below, I affirm and agree that:

I agree to actively participate in the Florida A&M College of Law Mentoring Program and will devote the time and energy necessary to participate fully and effectively in the Program. I understand that this application does not guarantee my assignment of a mentor or mentee.I meet the criteria for serving as a mentor/mentee and the information on this application is correct to the best of my knowledge.I understand that participation in the program does not provide any confidentiality to the conversations that occur as a result of participation.Except for extraordinary circumstances, I agree to:

(1) attend the Kick-Off Meeting and the Year End Meeting of Mentors/Mentee;

(2) Meet in person with my mentor/mentee no less than four times during the academic calendar year;

(3) Attend at least one of two group mentoring meetings during the academic calendar year.

For and in consideration of the terms of this FAMU Law Mentoring Program, including my participation therein, I hereby fully and forever release, waive, remise, acquit, satisfy and discharge:

(a) FAMU College of Law and its directors, officers, trustees, faculty, administrators, agents, employees and representatives; and

(b) The FAMU Law Mentoring Program’s mentors, mentees and program administrators;

of and from any and all claims, causes of action, demands, damages, actions, injuries, rights of action, loss of wages, expenses, compensation, costs and any other relief, in law or equity, known and unknown, which I now have and in the future that I may have, arising out of or relating to my participation in the FAMU Law Mentoring Program, including, without limitation, all claims and causes of action for negligence.

SignatureI agree to the terms and conditions

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Printed Name

Date