Mentorship Agreement Form
Mentoring ensures that knowledge, resources, and advice can be transferred between employees. The following form is to help organize and solidify the relationship between mentor and mentee. It is to be filled out together.

Mentor (Printed)		Mentee (Printed)	
			
Date

The following are key skills/training objectives to be covered:	

		

		

Key activities to achieve goals outlined (above):	

		

		

Responsibilities of the Mentor (check all that apply):
□	Helping the mentee to identify clear learning objectives	
□	Providing information and feedback (progress made, areas for improvement)	
□	Demonstrating effective, essential skills	
□	Referring the mentee to appropriate resources	
□	Supporting and encouraging mentee	
□	Scheduling meetings with the mentee	
□	Maintaining trust and respect	
□	Maintaining confidentiality	
□	Other: 	

Responsibilities of the Mentee (check all that apply):
□	Helping to identify clear learning objectives	
□	Working to achieve and surpass goals	
□	Seeking guidance from the mentor	
□	Remaining open to suggestions and opinions	
□	Accepting responsibilities for decisions and actions	
□	Carrying out tasks and learning activities	
□	Maintaining trust and respect	
□	Maintaining confidentiality	
□	Other:	

We agree this information will be kept confidential.

Mentor (Signature)		Mentee (Signature)	
			
Date