Forms and Worksheets

Mentoring Agreement Forms

Once the Mentee and Mentor have agreed to initiate a mentoring partnership, the appropriate agreement needs to be completed during their first official meeting. These agreements will give the pair the opportunity to discuss the parameters and expectations of their relationship. The agreements will also serve as a tool for the JUMP Manager, who will use them during periodic follow-ups in the first year of the relationship.

If you are unsure of which form to use, please contact Diana Cornelison, JUMP Manager at

Career Mentoring Agreement: Word form; PDF form

Content-Specific Mentoring Agreement:Word form; PDF form

Scholarly Mentoring Agreement:Word formPDF form

General Forms and Checklists

A number of tools have been created to help the mentoring pair during their relationship. These are optional but it is hoped that they will be used to keep track of progress and to enhance the mentoring experience.

Checklist for Your First Meeting:Word checklist; PDF checklist

Checklist for Ongoing Meetings: Word checklist; PDF checklist

Feedback Checklist:Word checklist; PDF checklist

Mentoring Meeting Worksheet: Word worksheet; PDF worksheet

Mentoring Relationship Interview form: Word form; PDF form

Ending the Mentoring Partnership form:Word form; PDF form

Departmental Mentoring Facilitator Forms

Quick Reference

Steven M. Block, MBBCH
Senior Associate Dean for Faculty Affairs and Career Development


Rita Groce
Program Manager


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Last Updated: 04-11-2014
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Disclaimer: The information on this website is for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, evaluation or care from your physician or other qualified health care provider.