Appendix © Mentor Consent Form ‘The role ofthe Mentor isto serve as an expert in the field chosen by the student. By signiag this form, the mentor agices to: allocate time (8 minimum of ten hours) to work with the student; provide insight iano the ‘waning, expectations, and demands ofthe field: ensure thatthe student is atively involved during shadowing and not simply observing If desied, the mentor may provide suggestions, advice, and support regarding the ‘evelopment ofa tangible produet that connees tothe real-world requirements ofthe career. Student Name Eonly Cnddasc Project Topi Mentor Name AY \jobulle Co. Pees oF Enployment Cploareus Callene of eal Serorrac, _ Work Addes ADL (Wertreal Dont Or Conard NC 25035 Preferred Emil 03 (us Prefered Phone FOU LAG = CUM Occupation Title / Expertise Related to Topie Surgyen! sLichnaloy Prcogorn Dwrector, Yeas of experince intopicara 1G WMOAG, For the protcetion of myself and the student, agree that we will not meet alone. {agrce to uphold the roles/duties of the project mentor tothe best of y ability. also confirm that Iam not related tc the student Mentor see TY hud Sod ae 4-29-18, Parent Signature Date Student Signature Date