MLA Mentor Agreement

Mentor Agreement Form

Please use this form to claim Academy of Health Information Professionals points for your mentoring activities, including mentoring colleagues, students, and for other mentoring activities, like career fair presentations.

Mentor(Required)

First Last

Email(Required)

Mentee(Required)

First Last

Email(Required)

Goals of Mentor/Mentee Relationship(Required)

(Please complete a short description of goals, and proposed timeframe, i.e.: contact once per quarter. You may expand this form onto a second page.)

Mentor Signature

Date

Mentee Signature

Date

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MLA Mentor Agreement

Mentor Agreement Form