National Association of Guide Dog Users 
2016 Mentoring Program Application 
All questions but the last are required. 
This application is to serve as a method for getting to know you. It is not a determination of your eligibility for the program, but it will help us match you with the right mentor or mentee. 
1. Are you interested in being a mentor or a mentee? 
2. First Name 
3. Last Name: 
4. Date of birth: mm/dd/yyyy 
5. Mobile Phone, where you can be reached during convention: 
6. Email Address: 
7. State of Residence: 
8. Are you a member of the National Association of Guide Dog Users? 
9. If no, are you interested in becoming a member? 
10. Please confirm that you are available to attend the meeting of the National Association of Guide Dog Users, which will take place on July 2, 2016, from 6-10 PM. 
11. Please confirm that you are willing and able to work at least one two-hour shift at the NAGDU table in the exhibit hall during its hours of operation during the convention. 
12. How many NFB national conventions have you attended? 
13. How many of these conventions have you attended with a guide dog?
14. From what training program did you receive your dog, or was it owner trained? 
15. Please list any other divisions of the NFB that you are involved with (Students, Parents, etc.) 
16. What are your career aspirations? If you are already employed, what do you do? 
17. What do you wish to accomplish by participating in this program? 
18. Is there anything else that you would like to share with the committee that would help us determine the best person to match you with?