Beyond the first year of the pilot program, how long, ideally, we would like to continue the mentoring relationship:

    How often and in what format we plan to meet (In office? Over coffee? For lunch? Other?):

  Approximate amount of time to be invested by the mentor and mentee (per week or per month):

    Specific role of the mentor (model, guide, observe and give feedback on teaching or writing etc. See the list of mentoring activities, topics and mutual interests):

Activities the mentee engages to perform to reach her goals (list here major goals of mentee and the smaller steps the mentee needs to accomplish to achieve those goals.):

  How we will deal with issues of confidentiality:

  We understand that the following activities are a requirement of the Faculty Mentoring Program for Women:

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Sign a consent form so results of the program may be published

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Sign the partnering agreement with mentoring partner

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Establish a working relationship with mentoring partner

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Participate in mid-year focus group

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Complete a year-end program evaluation

Note: We agree to a no fault conclusion of this relationship if, for any reason, it seems appropriate. We understand that we may turn to our college representative or to anyone on the Faculty Mentoring Program Committee to request that we be reassigned at the end of the semester.

                                                                                                                                                  
Mentee                                                                        Date

                                                                                                                                                
Mentor                                                                        Date

Adapted from Rooney, Ida, Nolt and Ahern, 1989, and Brainerd, 1998 by Tine Reimers for the Faculty Mentoring Program for Women at the University of Texas at El Paso