Nursing Department Peer Mentee Application and Agreement
To apply to be a Peer Mentee, please answer the following two questions and sign the
agreement below. Email to the Peer Mentor Coordinator at mary.sayler@nhcc.edu
1. Describe why you would like to have a peer mentor.
2. What do you expect to gain from the peer mentor experience?
I am committing to participate in the NHCC Nursing Department Peer Mentor Program.
I understand that this commitment is for one semester, starting the date of signature.
In this program I commit to:
 One orientation meeting prior to start of semester to meet my mentor
 At least twice monthly meetings with my mentor, one per month which is face to face as
possible given pandemic conditions
 Maintaining confidentiality of the mentor/mentee meetings, unless deemed necessary to
share information with the facilitator
 Completion of an evaluation survey of the experience
Print Name: ____________________________
Signature: ______________________________
Date: __________________________________
Facilitator Name: _________________________
Facilitator Signature: ______________________
Date: ___________________________________