- Mentor
- Complete in the editable or printed copy.
- Learner
- Complete in the editable or printed copy.
- Start date
- Complete in the editable or printed copy.
- Planned end or review date
- Complete in the editable or printed copy.
- Meeting frequency
- Complete in the editable or printed copy.
Purpose
Learner Goals
Mentor Commitments
- Provide candid, respectful feedback.
- Help the learner identify evidence, options, and next actions.
- Share perspective and connections without taking ownership of the learner's work.
- Protect appropriate confidentiality and explain its limits.
- Maintain professional boundaries and disclose conflicts of interest.
Learner Commitments
- Prepare for meetings and complete agreed actions.
- Ask questions and disclose obstacles early.
- Own decisions, work products, and follow-through.
- Protect confidential information and use only authorized resources.
- Give feedback on the mentoring relationship.
Communication and Boundaries
| Decision | Agreement |
|---|---|
| Channels | |
| Typical response time | |
| Rescheduling | |
| Topics outside the mentor's role | |
| Employment or recommendation expectations | |
| Confidentiality and reporting obligations | |
| How either person may end the relationship |
Signatures or acknowledgement: ______________________________