Name

Phone

Email

Place of employment (if retired, previous employment)

Work Address

Title

Nature of Work

Current AIGA Member?
YesNo

Membership in organizations or affiliations other than AIGA

Other Interests

Mentoring Information

Please note all areas in which you would feel comfortable mentoring. Add comments in the space provided if you feel them relevant to your qualications.

PrintWeb Design/Interactive MediaMarketing/AdvertisingIllustrationScreen Printing/PrintmakingVideo AnimationPhotography

Other

If there is a specific student that you would like to mentor, please provide their name.

I would be willing to mentor 2 students if necessary

Additional Comments

Please enter the Captcha code shown above.