School of Management and Business Studies
Mahatma Gandhi University, Kottayam
STUDENT MENTORING AGREEMENT
Name of the Mentor
Department
Name of Mentee
Programme
Date
I agree to take part in the University Mentoring Programme until end of the course.
However, I am aware that I can finish the Mentoring relationship
at any time by notifying my Mentor that I wish to withdraw from the Scheme
I have read and understand the University Mentoring Policy and I know which areas of
my University life my Mentor will help me with.
I understand and agree to follow the Schools/Departments/Centers Mentoring
Confidentiality Policy and have signed a copy.
I will meet with my Mentor once every (vary as appropriate) two weeks for 30 minutes.
We will meet in the Schools/Departments/Centers on University working hours.
I am happy for my Mentor to make brief notes of our meetings
If I have concerns about any aspect of the Peer Mentoring programme I will speak
to my Head of the Department of the Schools/Departments/Centers.
Email
Schools/Departments/Centers mail system
MENTEE RECORD
Name
Date of Birth
Nationality
State Photo
Native District
Native Thaluk
Native Village
Languages Known
Programme
School/Department
Student ID
Gender Male Female Transgender
Religion Caste Sub caste
Address for communication Present Permanent
Mobile number
Email ID
Parents details Fathers Name Mothers Name
Occupation Occupation
Mobile Number Mobile Number
Guardian details Name Address Mobile
number
Marital status Married Unmarried Others
Spouse Name
Occupation
Educational Qualifications
Degree/Diploma Board/university Name of the Year of Grade
institution Passing
SSLC/10th level
12th
Graduation
Post Graduation
M.Phil.
NET/JRF
Ph.D.
PDF
Any other
Teaching/ Professional Experience
Institution Post From To Total
Personal Details
Blood Group
Any physical impairment Physical Visual Auditory Any other
Are you under any
medication
Any other relevant
information to communicate
Signature of Mentee
Name and signature of the
mentor assigned
Name and signature of the
Head of the
Schools/Departments/Centers
RECORD ON MENTOR –MENTEE MEETING
Name of the Mentor
Department
Name of Mentee
Programme
Date
Topics Discussed 1. Academic
2. Professional
3. Personal
4. Any other
Action taken/needed 1. Career counseling
2. Personal counseling
3. Advised for Medical support
4. Asked to meet consult expert
5. Any other
Feedback of Last meeting
Name and signature Mentor Mentee
STUDENT MENTORING EVALUATION
Name of Mentor
Programme
Head of the Schools/Departments/Centers
Date
Mentoring
Start date:
End date:
Number of meeting held:
Did you keep in contact between meetings: by e-mail; by text; by phone?
How frequently?
Do you feel that you have made a positive
difference to your mentee? Please give some
examples:
Do you feel you have gained from being part
of the mentoring programme?
Please give some examples:
Did you have any difficulties in taking part in
the programme? Please give some examples:
Name
Signature
