Mentor Application Form

First Name: *

Last Name: *

Nevada Bar Number: *

Please enter your three to five digit bar number only - no text.

Law Firm/Employer: *

Email Address: *

Number of Years in Practice in Nevada: *

Practice Type: *

Please select the option that best describes your practice type.

Office Size: *

I would like to mentor the following attorney, if known: (list name and bar number):

Are you willing to serve as a mentor to attorneys in solo practice or who practice in another firm?: *

Yes

No

Note: Every attempt will be made to pair mentors with newly admitted attorneys who practice in the same firm.

Do you have any disciplinary matters pending?: *

Yes

No

If you have disciplinary matters pending, please explain.:

Have you ever had a finding of discipline - public or private - in this or any other jurisdiction?: *

Yes

No

Note: While discipline is NOT a per se disqualification, the failure to disclose discipline shall disqualify you from an appointment.

If you have ever had a finding of discipline - public or private - please explain:

Discipline Confidentiality Waiver: *

Yes

No

By checking "Yes" above, I do hereby waive any confidentiality and consent to disclosure to the Board of Governors of all discipline files and records in jurisdictions where I am or have been admitted to practice regarding any complaints filed against me, open or closed, pending or resolved for the limited purpose of considering my application in this appointment process.

Click here for a Discipline Key.

Please provide a brief statement indicating why you wish to serve as a mentor and what you can contribute.: *

Minimum Qualifications. I certify I possess the following minimum to serve as a mentor: *

(1) I am a member of the State Bar of Nevada in good standing with no prior disciplinary actions in the past ten years, except as disclosed above; (2) I have at least seven years of practice experience in the State of Nevada; (3) I possess a reputation in the local legal community for competence and ethical and professional conduct; (4) I have not had any sanctions, suspensions or disbarments in any state from the practice of law in the past ten years; (5) I carry and can provide proof of a $500,000 minimum malpractice insurance policy (private practitioners only); (6) By submitting this form, I agree to adhere to the Mentor Agreement; and (7) I agree to maintain the aforementioned qualifications once appointed as a mentor and must prove to be an asset to the TIP program as determined by the mentor evaluation process at the conclusion of each program cycle.

Mentor Agreement

Malpractice Insurance Policy: *

Yes

N/A

By checking this box, I attest to having a $500,000 minimum malpractice insurance policy (private practitioners only). If you are not in private practice, check N/A.

I attest to the information provided in this application as true to the best of my knowledge: *

Yes

If you have been referred by someone at the State Bar to serve as a mentor, please let us know who referred you:

Resume: *

Please select the file from your computer and click the submit button. Your file will be automatically attached.