BOOM Mentor Information &
Agreement
Mentor Information
Name: _______________________________________________
Student ID #: ____________
VCCS Email: ___________________________________________
Personal Email (optional): ___________________________________________
Phone #: _________________________
Mentor Agreement
____ I agree to be available to mentee via email (JTCC) or in-person. I may elect to swap telephone or
other personal communications (phone, Facebook, personal email).
____ I agree that the mentor/mentee relationship should be maintained in a professional manner.
____ I agree that the mentoring relationship is formed outside of regular classroom activity, and within
the confines of all JTCC institutional policies, rules, codes of conduct, and regulations.
____ I agree to stay in regular contact with the mentee. (Approximately 30 minutes per week)
____ I acknowledge that I will not take part in activities that are covered by services provided by John
Tyler Community College. I will not serve as a tutor, editor, academic advisor, or any other position
already represented at JTCC.
____ I agree to contact the Beta Omicron Omicron chapter advisors as soon as possible if there are any
problems, issues, or concerns about a mentor/mentee agreement.
OFFICE ONLY
Date submitted: ___________
Mentee assigned: ______________________________________
Advisor initials: __________