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 Henne Thewepsen Project Topic ___ Agase Sree eee eee Mentor Name See Aue Bing bonen bon An cow Place of Employment Tiskeaprech me Meéless Solutinns Work Address 2% Old Mocwsyitl Me WC Preferred Email 2: lws : aaetl Preferred Phone__ Jo SY2 or 3S Occupation / Title / Expertise Related to Topic_hacensed Clinical Social Wle the ~- wa Years of experience in topic area Ile Uyrs 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 projec) mentor to the best of my ability. I also confirm that I am not related to the student. ‘Mentor Signatu: Parent Signature Date Student Signature Date