Mentor Agreement

(Please use this form to claim Academy of Health Information Professionals points for mentoring activities including mentoring colleagues, students, and other mentoring activities. This also includes career fair presentations).

Mentor: _______________________________________________________

Mentee: _________________________________________________________

Goals of Mentor/Mentee Relationship (Please complete a short description of goals, and proposed timeframe, i.e., contact once per quarter).

Signature: Mentor Date

Signature: Mentee Date

(To receive academy points, complete and submit this form with your academy application and accompanying materials).