— 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 E01) Thomas rrjecrtonic Chrilel Psy chioctoy Mentor Name JA(IRie act: Place of Employment Integrative Nellness. Solutions Work Address JOekie- IWS Counseling @ yahoo: com Preferred Email \2\_ Gateway Blvd Suite Moscesuille NC 238i Preferred Phone 104 82 0354 Occupation / Title / Expertise Related to Topic_Liceceed Pre€essional Counselor, estes in tA in School Coveseling ‘Years of experience in topic area LEC- 2 Schoo! counseling ~A yeacS 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 — Gael Date__|[O-2Q-17 pare 21 [2217 (Aol7 Student Signatire Ge jw pare 09/247 a