02/26/2018 14:08 FAX 7047952959 Bo0z/002 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 shadowi and not simply observing. If desired, the mentor may provide suggestions, advice, and support regarding the development of a tangible product that conncets to the real-world requirements of the career. Student Name, wW Machin Project Topic A CoN l Mentor Name <} er per Place of Employment lor Phusical The rag Work adaress ]I4G0" Old Jethon Road Preferred Email Sau |e + COM Preferred Phone ZO4- 3.S55-GS7 Occupation / Title / Expertise Related to Topic ad. Phusi ca’ isk - Years of experience in topic area__ “3 For the protection of myself and the student, | agrec that we will not mect alone. I agree to uphold the ‘toles/duties of the project mentor to the best of my ability. I aso confitm that I am not related to the student. Mentor Signature Uri Shy, ire vae_2/26//8 Parent Signature Student Signature