‘entor Consent Form ‘The role of the Mentor is to serve as an expert in the field chosen by the student, sy signing this torm. we mentor agrees to: allocate time (a minimum of ten hours) to work with the student: proviae insient 1: training, expectations, and demands of the field; ensure that the student is actively involved auring shadowing ! not simply observing. If desired, the mentor may provide suggestions, advice, and support regarding the lopment of a tangibie product that connects to the real-world requirements of the career. student name A VOY / w/t rf SC Cr)e C Project Topic Mentor Name DV J Upria _,d.C. Place of Employment Perforce Fchab Asso sake ot Lake Normal ok Lake Nonny Work Adaress (315 w. Coda Aw Stew \00 Cornelius Nu 2803) Preferred Email CCL @ pva Jon tow Preferred Phone (A) SAW-\S\. Occupation / Title / Expertise Related to Topic (An\\/ sunheidiad Eevdise Solace _ Years of exjetience mropicare. \O + Ves 5 usieSS Ow “cx the prowection of myseif and the student, I agree that we will not meet alone. I agree to uphold the roles/duties of the project mentor lity. | also confirm that I am not related to the student. RO owe Vo afecrg vue WIZL 7 Date 4/18/2011 Mentor Signature _— Parent Signa Student sina’ Honas Hous