Question #1 (Required)

First Name:

Last Name:

Question #2 (Required)

Preferred E-mail Address:

Question #3 (Required)

Firm/Employer Name:

Question #4 (Optional)

Title:

Question #5 (Optional)

Work Address:

Question #6 (Optional)

Preferred Phone Number:

Extension (If Applicable):

Question #7 (Required)

Are you an:
Accountant?
Attorney?
Both?

Question #8 (Optional)

If you are an attorney, please tell us about your current practice status.
Active License
Inactive License
JD Advantage
Retired

Question #9 (Optional)

If you are an accountant, please tell us about your current practice status.
Active CPA License
Inactive CPA License
No CPA License
Working toward CPA License
Retired

Question #10 (Optional)

Question #11 (Optional)

Are you willing to mentor more than one student?
Yes
No

If yes, how many?

Question #12 (Optional)

What level of student would you like to mentor (Please check all that apply)?
Full-Time
Part-Time
Onsite Student (planning to attend classes onsite)
Online Student (planning to attend classes online)
Accountant
Attorney

Question #13 (Required)

What primary areas of tax do you specialize in? (Please check all that apply)
Business Planning
Consolidated Returns
Corporate Taxation
Employee Benefits
Employment Taxes
Estate Planning
Executive Compensation
Exempt Organizations
Fiduciary Income Taxation
Individual Tax Planning
International - Inbound
International - Outbound
Mergers and Acquisitions
Natural Resources
Partnerships
Qualified Plans
Real Estate
S Corporations
State and Local
Tax Accounting
Tax Controversies
Wealth Transfer
Other (Please Specify)

If "Other", please identify the area (20 word limit):

Question #14 (Required)

Please tell us about your practice setting:
Small Firm
Medium Firm
Large Firm
Solo Practitioner
Government
In-House Counsel (For Profit)
In-House Counsel (Non-Profit)
Judge
JD Advantage
Other (Please Specify)

If "Other", please identify the setting (20 word limit):

Question #15 (Optional)

Please provide any of the following information you are willing to provide about yourself:

Gender:
Male
Female

Race/Ethnicity:
Hispanic or Latino
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Caucasian

Other characteristics:
LGBT
Military Veteran
Single Parent
Second Career
First Generation College Graduate

Question #16 (Required)

Experience Level:
< 5 years
5 to 10 years
10 to 20 years
> 20 years

Question #17 (Optional)

Please identify any preferences you have for your mentee (Please check all that apply):

Gender:
No Preference
Male
Female

Race/Ethnicity:
No Preference
Hispanic or Latino
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
Caucasian

Other characteristics:
No Preference
LGBT
Military Veteran
Single Parent
Second Career
First Generation College Graduate

Agreement & Acknowledgement of Responsibilities: (Required)

I understand that this is a professional program and I agree to conduct myself in a professional manner during all interactions with my student. I agree to make reasonable effort to initiate and maintain contact with my student. I agree that, if I am unable to meet with a student during a scheduled time or need to cancel a meeting, I will notify the student as soon as possible. I agree to contact the Program if I cannot or will not continue with the Program.

Electronic Signature:

(Please Note: Because mentors often have very busy schedules and students are often still learning how to communicate professionally, we ask that mentors be responsible for initiating contact with students and scheduling meetings. Thanks for your cooperation.)