SLIS - Scholarship Application

Request to Register a School Library Mentor

Are you requesting a mentor for the first time, or are you requesting to change your mentor?
first time change my mentor

If you are requesting to change your mentor please explain why:

Student Contact Information

First Name: Last Name:

Street Address:

City: State:
Country: Postal/Zip Code:

Home Phone: Work Phone: Cell Phone:

Preferred Email Address:

Eaglemail Email Address:

Student Employment Status

Are you currently working? yes no

What type of employee are you?

What type of position do you currently hold:

What level is your current position:

Name of the school you are currently at:

School district you currently work in:

Region you currently work in:

Is your primary interest in elementary or secondary school libraries?
elementary secondary

Mentor Request Information

There are several Districts and Regions in Texas where you, the student, are placed with a mentor ONLY by going through one Designated Contact Person. That person determines which librarians in the area can best serve as mentors to students for the completion of the practical requirement of this certification/masters.

If you are making arrangements for a mentor with the designated contact person for a region or school district that assigns mentors, please select the appropriate region, or school district, below.

Designated Contact Person List:

If you are seeking a mentor in a school district, or region, that DOES NOT have a Designated Contact Person please complete the following:

Mentor Information

First Name: Last Name:

City: State:
Country: Zip Code:

Home Phone: Work Phone: Cell Phone:

Preferred Email Address:

School Name:

District: Region: