Please supply us with the information requested below. All information marked with an asterisk is required. This will complete the information sign-up process. Your application cannot be accepted unless you real and agree to the Mentor Disclaimer and Release.

Mentor Disclaimer and Release

I understand that as a mentor participating in the Illinois State Bar Association Mentoring Program, any advice I provide in the course of the mentoring relationship is solely for the purpose of guiding the mentee in the practice of law. I understand this relationship is an educational resource to discuss general issues confronted in the practice of law, including, but not limited to, attorney/client relations, law office administration and management, professionalism and legal ethics. I understand that the mentee will not rely upon my advice and/or statements as legal advice. I agree that I am not representing any of the mentee's clients or rendering legal advice to any client through the mentee.

I understand and agree that the information I provide in the course of the mentorship will not be relied upon by the mentee as a substitute for his/her own independent judgment or professional legal opinions. I understand that I am not a supervising lawyer as defined by Rule 5.1 of the Illinois Rules of Professional Conduct. Neither I nor the Illinois State Bar Association provides any warranty for information shared, divulged or given to the mentee.

I recognize and agree that if I receive knowledge that the mentee has engaged in professional misconduct, I may be obligated to report the conduct, if required by Rule 8.3 of the Illinois Rules of Professional Conduct.

I hereby agree that in no event will I file suit or otherwise attempt to hold liable for damages, the Illinois State Bar Association, any mentee, member, staff or agent of the Illinois State Bar Association as a result of my participation in this program. As a mentor, I agree to indemnify and hold harmless the Illinois State Bar Association from any and all claims, suits, actions or proceedings of any kind arising out of, or in connection with, any advice or guidance I give in relation to this program.

I agree       I do not agree*
*Note: you must agree to the terms of this disclaimer and release to serve as a mentor.

Application to Serve as an ISBA Mentor

Note that this information will be disclosed on the ISBA website to potential mentees.

*Name:
*County(ies)
Office address:
*City:
*State:
Zip:
ARDC#:
*Phone #:
Fax #:
*E-mail address:

I am also licensed to practice law in the following states:

*I prefer mentees contact me via (check all that apply): phone   e-mail
*My insurance company is:
My policy number is:
My policy expires: 

By placing my name on this electronic document and submitting it to the ISBA, I hereby authorize the ISBA to determine from the Attorney Registration and Disciplinary Commission that I am a member in good standing before the Bar of Illinois. I agree to accept a status of suspension from serving as a mentor during such time as a complaint may be pending as voted by the inquiry Board of the Attorney Registration and Disciplinary Commission and until such time as the complaint is either dismissed or the participant-member is permitted to resume practice by the Illinois Supreme Court.

I accept: Federal cases Appellate cases

I speak the following languages (foreign, sign, etc.):

Authorization is hereby given to determine from the Attorney Registration and Disciplinary Commission that I am a member in good standing before the Bar of Illinois as provided in Rule IV.D.4. I agree to accept a status of suspension from serving as a mentor during such time as a complaint may be pending as voted by the inquiry Board of the Attorney Registration and Disciplinary Commission and until such time as the complaint is either dismissed or the participant-member is permitted to resume practice by the Illinois Supreme Court.

Yes No 

Please check all areas in which you would like to serve as a mentor:

  1. Addressing Personal & Professional Demands of Practice

  2. 1. Balancing Your Personal & Professional Life
    2. Running Your Law Office Like a Business
    3. Sole Practitioner/Hanging Out Your Shingle

  3. Substantive Law Areas

  4. 1.Administrative Law
    2.Agriculture
    3.American Disabilities Act
    4.Animal Law
    5.Appellate Practice
    6.Aviation
    7.Banking
    8.Bankruptcy
    9.Civil Rights
    10.Civil Practice (general)
    11.Collection
    12.Condemnation/Eminent Domain
    13.Consumer Complaint/Warranty
    14.Contracts
    15.Corporate & Business Law a.Franchise 16.Criminal (general) a.Criminal appeals
    b.Felony
    c.Misdemeanor
    d.Prisoner Rights
    17.Domestic/Family a.Domestic violence
    b.Fathers/Mothers' rights
    c.Grandparents' rights
    d.Guardianship
    e.Child custody/support
    f.Visitation
    g.Paternity
    h.Divorce/Separation/Annulment
    i.Adoption
    18.Disability
    19.Drainage and Water Rights
    20.Elder Law a.Nursing home issues 21.Employment/Discrimination (general) a.Sexual Harassment
    b.Retirement benefits
    c.Discrimination
    d.Labor relations
    e.Unemployment Comp
    22.Environmental
    23.Estates, Trust & Wills
    24.Federal Practice
    25.Government Relations
    26.Healthcare
    27.Immigration/Naturalization
    28.Injunctions
    29.International Law
    30.Insurance
    31.Juvenile
    32.Licensing
    33.Malpractice a.Legal
    b.Medical
    c.Dental
    d.Veterinarian
    34.Mediation/Arbitration
    35.Medicare/Medicaid
    36.Military a.Veterans Benefits
    b.Veterans Malpractice
    37.Mineral Rights
    38.Motor Vehicles a. Car insurance 39.Municipal Law
    40.Patent/Trademark a.Intellectual Property
    b.Entertainment
    41.Pension
    42.Personal Injury/Wrongful Death
    43.Public Aid
    44.Real Estate
    45.Real Estate Taxation
    46.Securities
    47.Social Security
    48.Taxation
    49.Tenant/Landlord
    50.Traffic
    51.Transportation
    52.Workers' Compensation
    53.Zoning
    54.Other (please list):

Biographical Information

Year of Admission:
Law School:
Other States/Jurisdictions Admitted In:
Professional Associations :
Honors:
Publications/Seminars:

Age:

Gender:

Male    Female

Identifications with Racial/Ethnic Groups:

Non-Work-Related Pastimes:

Area of Mentoring Interest (Check any/all which may apply):
ad hoc inquiries on substantive areas
on-going mentoring relationship
other (please describe):