Mentor Information and Agreement Form

MENTOR INFORMATION AND AGREEMENT FORM

(To be completed and returned to your English teacher)

Name: _________________________________________________________________________________

Type of Business: ___________________________________________________________________________

Address: _________________________________________________________________________________

__________________________________________________________________________________

Telephone Numbers: Office: ________________________________________________________

Home: ________________________________________________________

Cell: ________________________________________________________

Fax: ________________________________________________________

Email: ____________________________________________________

Best time(s) to be contacted ______________________________________

Mentor Agreement to Serve

For Mentor to complete and sign

I agree to serve as a Senior Project Mentor to ______________________________________. I will advise and assist with his/her Senior Project Product plans to ____________________________________________

_______________________________________________________________________________________________

______________________________________________ __________________________

Mentor Signature Date

Parent Approval of Mentor

For Parent to complete and sign

I am aware that ________________________________________ will be serving as a Senior Project Mentor for ________________________________________, and give my permission for them to meet together for the required 15 hours. I understand that these meetings will be scheduled at mutually agreeable times and will take place at ________________________________________.

______________________________ ___________________________

Mentor Agreement to Serve

For Mentor to complete and sign

Mentor Signature Date

For Parent to complete and sign

Parent/Guardian Signature Date