| Please print out, complete and return this portion to the membership chair if you are interested in becoming or
having a mentor for the next school year. Return the form to one of the following: |
|
| Co-Membership/Mentor Chairs Paulette DiVall Riverdale Schools 203 E. State St. Monfort WI 53569 pdivall@riverdale.k12.wi.us (608) 739-3101 or Mary Kay Logemann Platteville School District 431 S. Van Buren Lancaster WI 53813 logemann@platteville.k12.wi.us (608) 342-4013 |
|
| _______ Yes, I would like to be a mentor. | |
| _______ Yes, I am a new school nurse and would like to have a mentor. | |
| _______ Yes, I am a new school nurse and would like the Welcome Packet. | |
| Name:__________________________________ | |
| School district: ___________________________________ | |
| Home phone: ( ) ___________________ | |
| Work phone: ( ) ___________________ | |
| Home address ________________________________________ | |
| Work address ________________________________________ | |