Responsibilities

Track interaction and maintain records with Mentee (using provided form)
Complete questionnaire, survey or assessment (when scheduled/quarterly)
Understand that Mentor Training is Required
Tracking Notes and recommendations are part of productivity/product of LHI
Provide 2-3 recommendations per quarter based on several Mentee interactions and discussions
Facilitate, assist, and develop Action Plans with Mentees

Full Name *

Title/Rank

Institutional Affiliation

Department/Office

Years in Field

Faculty Member

Yes

University administrative personnel

Yes

Community Mentor

Yes

Responsibilities:

Track interaction and maintain records with Mentee (using provided form);
Complete questionnaire, survey or assessment (when scheduled/quarterly)
Understand that Mentor Training is Required
Tracking Notes and recommendations are part of productivity/product of LHI
Provide 2-3 recommendations per quarter based on several Mentee interactions and discussions
Facilitate, assist, and develop Action Plans with Mentees

Email *

Phone *

Mentor Applicant Signature *

Mentor Application Date *

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