Chinese American Librarians Association Midwest Chapter Mentor Program

CALA Midwest Chapter Mentorship Program Application Form

First Name:

Last Name:

Position Title:

Institutional Address:

City/State/Zip:

State: Zip Code:

Telephone/Fax:

Fax:

Email:

I would like to be a:

Mentee Mentor

Are you a CALA member?

Yes No

Applicant will be matched based on the information provided below.

Type of institution in which you are interested or in which you have had experience:

If selection is other please specify institution type:

Years in service: Library School Student 1-6 7-14 15 and above Retired

Areas in which you are interested or in which you have had experience:
Public Services Technical Services Automation Administration Library Instruction Other

If selection is other, please specify interested position type:

Supply other helpful info.: (research interests, specialties, special concerns or needs, etc.)


	Do you have other questions? Can't read the form? Contact one of the members of the CALA Midwest Membership Committee:
	Xiaohong Xiao Federal Reserve Bank of St. Louis St. Louis, MO 63102 Email: xiaohong.a.xiao@frb.stls.org	Haipeng Li Oberlin College Library 148 West College Street Oberlin, Ohio 44074 Email: haipeng.li@oberlin.edu

First Name:
Last Name:
Position Title:
Institutional Address:
City/State/Zip:	State: Zip Code:
Telephone/Fax:	Fax:
Email:
I would like to be a:	Mentee Mentor
Are you a CALA member?	Yes No
*Applicant will be matched based on the information provided below.* Type of institution in which you are interested or in which you have had experience: If selection is other please specify institution type: Years in service: Library School Student 1-6 7-14 15 and above Retired Areas in which you are interested or in which you have had experience: Public Services Technical Services Automation Administration Library Instruction Other If selection is other, please specify interested position type: Supply other helpful info.: (research interests, specialties, special concerns or needs, etc.)