The Iowa Bar Association Mentor Program – Mentee Application

ISBA Member # Year Licensed in Iowa:

Full Name: Employer/Firm Name:

Street Address: City:

State: Zip Code:

Phone: Email:

Judicial District: Other Jurisdictions:




About You

The following information will be used to create a Mentee profile that will be accessible only to those involved in the pairing process. Personal questions (e.g. inquiries regarding marital status, children, etc.) are optional, but are helpful to ensure we have information to help make successful matches on both professional and personal levels. This information is not designed to serve as “preferences” for a Mentor. If you have preferences related to personal characteristics or other data (such as location), you may indicate those requests separately on the application. A separate “Confidential” information section is found at the end of the application, and any information provided there will be used by the Committee to help make a match but will not be provided to individuals outside the Committee, including the Mentee.

Undergraduate School:

Year of Graduation: Major(s):

Law School: Year of Graduation:

Other Education:
Year of Graduation:

Date of Birth:

If you are employed, please provide information about your employment ( do not need to be employed to participate in the Mentor program)

Employer/Firm Name:

Employer complete address:

Employer phone# Employer fax#




Please select up to three areas which best describe your practice:







































Type of Practice:





Number of Attorneys:




Practice areas not listed:

Bar related activities:

Civic activities:

Hobbies and interests:

Additional relevant information:

Pro Bono:




Mentor Preferences

We cannot guarantee that all preferences will be satisfied, but we will attempt to take them into consideration when making a match. If there are certain qualities that are most important, please note that at the end of this section.

Please select up to three areas in which you would like your mentor to have knowledge/experience:
































Type of Practice:





Number of Attorneys:




Do you have any other requests or preferences for your ideal mentor? (i.e. distance/location/personal)*


I would like to be mentored by the following attorney (if known)*

Name: Email/Phone:


* Prefeences will be taken into consideration, but the program cannot guarantee that all preferences will be met with each match

** Match requests must still meet general program requirements (i.e. not a member of the same firm) and will be honored if possible, but are not guaranteed




MENTEE REQUIREMENTS (Please check all that apply – Must meet all requirements to participate):









Confidential information


Disability? If yes, please describe:

Are you married? Do you have children?

Race: Sex:

Sexual Orientation:

Confidential comments regarding a match/preference:





Please review the following information and sign to complete your application

By completing and submitting this application to participate in the Iowa State Bar Association Mentor Program, I am acknowledging that:
  • I wish to participate as a Mentee in the Iowa State Bar Association Mentor Program in accordance with its rules and regulations.
  • I acknowledge the information submitted herein is complete and accurate to the best of my knowledge.
  • I certify that I meet all of the Mentee requirements that I checked above.
  • If after I become a Mentee, I become subject to a public or formal disciplinary proceeding by any court or bar-related entity and/or am formally sanctioned in any jurisdiction, I will notify the Mentor Program Committee.
  • I understand that the Mentor to whom I am matched is determined and approved by the Iowa State Bar Association Mentor Committee and that there is no guarantee that I will be matched to a Mentor in the year requested.
  • I understand that this is a one-year commitment and this is not a program to help me obtain a job, but is designed to help me become acclimated to the practice of law and a serve as a productive, successful member of the Iowa legal community.
  • I agree to make the necessary time commitment to maintain a mentorship relationship. If my work or life circumstances change so that I cannot be involved in the program, I will contact the Iowa State Bar Association Mentor Committee.
  • I agree to read the orientation materials that will be provided to me and watch the training video or participate in a live training session.
  • I understand that the ISBA Mentor Program is a professional relationship. It does not contemplate and is not intended to create a formal association or attorney-client relationship between the Mentee and the Mentor and does not remove the need to be concerned with confidential or privileged information.
  • I understand that all information provided to the Iowa State Bar Association in this application will be kept private although it may be shared within the Iowa State Bar Association to administer the program and with the Mentor, except that “Confidential” information will not be shared with the Mentee.


Please check this box and type your name to confirm agreement with the terms above.

Type name to complete:




Questions can be directed to the Committee via
Email: mentorprogram@iowabar.org