Appendix C

Mentor Consent Form

The role of the Mentor is to serve as an expert in the field chosen by the student. By signing this form, the
mentor agrees to: allocate time (a minimum of ten hours) to work with the student; provide insight into the
training, expectations, and demands of the field; ensure that the student is actively involved during shadowing
and not simply observing. If desired, the mentor may provide suggestions, advice, and support regarding the
development of a tangible product that connects to the real-world requirements of the career.

Student Name Jokocfun

Project Topic pers onal Training war

Mentor Name ,Te.St'

Place of Employment ke ithrw).n Fi4-vtar

Work Address 1172,4 je.440v, 11_0,1 s-11, joy , , AK_ aro 31

Preferred Email 3soe ert Lic 414- se wig ;sh cone)
Preferred Phone (311) WS - 3/13

Occupation / Title / Expertise Related to Topic 54-re." / C_04c.

C , .44Cre eg .lit. Orr: d ie h

- - Cool L1 fe-/30 on.g I TrAN er
Years of experience in topic area years

For the protection of myself and the student, I agree that we will not meet alone. I agree to uphold the
roles/duties of the project mentor to the best of my ability. I also confirm that I am not related to the student.

Mentor Signature Date 6' - 3 - 17

,
Parent Signature Date 5

Student Signature Date 6'3"17