Name (Mentor)........................................................................................................
Preferred contact details........................................................................................
...................................................................................................................................
Name (Mentee).......................................................................................................
Preferred contact details........................................................................................
2.Planned frequency of contact ……………………………………………….
3.Medium
Face to face
Email
Phone
4. Venue / length of each meeting
……………………………………
5. Contact outside of scheduled meeting times to address urgent issues
Yes No
6. Agreed reasons for not keeping a scheduled appointment
………………………………………………………………………………………………
7. Length of notice required if not able to attend a meeting
.……………………………………………………………………………………………….
8.Mentoring activities will include
…………………………………………………………………………………………………
……………………………………………………………………………………….......…….
9. Length of the relationship
Open ended
Defined timeframe ending ……………………
10. Confidentiality
All communication occurring during the mentoring relationship will remain
confidential
unless mutually agreed otherwise
11. Proposed review date / process
……………………………………………………………………………………………………
…………………………………………………………………………………................………
12. Responsibility
The College of Nurses Aotearoa, New Zealand accepts no responsibility
for the success
(or otherwise) of any mentoring arrangement. The establishment, operation
and termination
of the relationship is the responsibility of the professionals involved.
Signed:
…………………………Mentor
………………………..Date
…………………………Mentee
……………...………...Date
