Section 3
POLICY AND PROCEDURE MANUAL
December 2009
National Center for Mentoring Excellence
Policy and Procedure Manual
Table of Contents
History
MISSION STATEMENT
Purpose
SECTION 1: PROGRAM PLANNING
1. General Responsibilities for State Coordinators
1.2 Financial Sustainability
1.3 Advisory Committee
1.4 Types of Mentoring Relationships
1.5 Location of Mentoring Activities
SECTION 2: Policies
2.1 Eligibility
2.2 Recruitment
2.3 Inquiry
2.4 Screening
2.5 Transportation
2.6 Overnight Visits and Out-of-town Travel
7. Training
2.7.1 Training and Activity Evaluations
2.8 Matching
2.9 Support and Supervision
2.10 Confidentiality
2.11 Record-keeping
2.12 Mandatory Reporting
2.13 Use of Alcohol, Drugs, and Firearms
2.14 Unacceptable Behavior
2.15 Recognition
2.16 Closure
2.17 Evaluation
Section 3.0: PROGRAM OPERATIONS AND PROCEDURES
3.1 Recruitment Procedure
Annual Mentor/Mentee Recruitment Plan
Semi-monthly Recruitment Activity Plan
2. Inquiry Procedure
Mentor Job Description
Mentor Application
Information Release
Mentor Interest Survey
Photographic Release
Mentee Referral
Mentee Application for Minors
Mentee Application
Mentee Interest Survey
3.3 Mentor Screening Procedure
Mentor Contact Sheet
Mentor Assessment Summary
Mentor Interview Form
Personal Reference Interview
Mentor Acceptance Letter
Mentor Rejection Letter
3.4 Mentee Screening Procedure
Mentee Contact Sheet
Mentee Assessment Summary
Mentee Interview Form
Mentee or Mentee/Parent Acceptance Letter
Mentee Rejection Letter
3.5 Matching Procedure
Mentor Contract
Mentee Contract
Parent/Guardian Contract (if mentee is under the age of 18)
3.6 Training Procedure
3.6.1 General Training Procedures
3.6.2 Initial Training Session
3. Mentoring Training/Activities
Training and Activity Evaluation Form
3.6.4 Five Essential Elements for Success
3.7 Match Support and Supervision Procedure
3.7.1 Supervision
3.7.2 Problem Resolution
3.8 Recognition Procedure
3.9 Mandatory Reporting of Abuse and Neglect Procedure
Abuse and Neglect Report
3.10 Closure Procedure
Match Closure Summary
Mentor Exit Survey
Mentee Exit Survey
Parent/Guardian Exit Survey
Closure Letter
Section 4.0: Evaluation Procedure
History
The National Federation of the Blind (NFB) Jernigan Institute created the National Center for Mentoring Excellence (NCME) for blind and low-vision youth and young adults as the result of a Demonstration Grant from the U.S. Department of Education, Rehabilitation Services Administration received in October 2004. This five-year research project has demonstrated what we in the National Federation of the Blind have known for decades—by connecting blind youth and young adults with successful adult blind mentors and role models, success for future generations is guaranteed.
The first year of the project was spent developing materials, hiring staff, and planning for the rollout of the mentoring programs in two demonstration states, Louisiana and Nebraska. A state coordinator was identified in each state with the primary responsibility of recruiting, screening, matching, and supporting the mentoring pairs. A target of twenty blind and low-vision youth and young adults, ages sixteen to twenty-six, from each state were recruited and screened to participate in the project.
At the beginning of the second year of the project, these young adults were matched with blind mentors who completed a screening process to make certain each possessed the right attitudes and skills necessary to serve as an appropriate mentor. Each mentoring pair committed to a two-year mentoring relationship that included participating in monthly face-to-face contact and weekly telephone calls and e-mails. Each state scheduled quarterly mentoring activities to help facilitate the mentoring relationship while serving as an opportunity for the youth to connect with other blind young adults.
Beginning in year three of the project, the initial demonstration states matched a second group of mentoring pairs for a two-year commitment. During the fourth and fifth years of the project, this model mentoring program was rolled out into additional replication states: Georgia, Ohio, Texas, and Utah. Relationships were established so that the members of the National Federation of the Blind in the identified states worked closely with their state agencies for the blind and the Jernigan Institute to formalize mentoring and develop model mentoring programs. Under this grant project, the replication states worked with their mentoring pairs through September 2009.
Although the demonstration grant from the U.S. Department of Education, Rehabilitation Services Administration ended, this model established by the NCME will be continued in the replication states. The NCME will work with additional states to implement mentoring programs that will connect blind youth with blind adult role models to bring a new generation of Federationists.
Mission Statement
The mission of the NCME is to link transition age blind and low-vision youth with successful blind mentors for the purpose of increasing knowledge of, and participation in, the vocational rehabilitation process, post-secondary academic success, high-quality employment, and community integration.
Purpose
The purpose of this manual is to outline policies and procedures that should be part of formal mentoring programs. This manual may be used as a guideline for youth coordinators of NFB affiliates to set policies and procedures for youth programs. This manual demonstrates best practices in mentoring as a result of what we have learned about the mentoring program from the past five years. NFB affiliates wishing to use this for their mentoring programs may use this manual and tailor it to the needs of their youth program. The NCME will be available to consult with states about their mentoring programs for blind youth and continue to be a resource for best practices in mentoring. For more information, go to mentoring or call (410) 659-9314 Ext 2295.
National Center for Mentoring Excellence
Policy and Procedure Manual
SECTION 1: PROGRAM PLANNING
1. General Responsibilities for State Coordinators
1.2 Financial Sustainability
1.3 Advisory Committee
1.4 Types of Mentoring Relationships
5. Location of Mentoring Activities
1.1 General Responsibilities for State Coordinators
The State Coordinator is responsible for the day-to-day operations of the mentoring program and carrying out the goals consistent with the guidelines and mission of the Mentoring Program.
Responsibilities include maintaining a high standard of excellence in mentoring based on best practices as outlined in the National Center for Mentoring Excellence Policy and Procedures Manual.
Responsibilities include but are not limited to:
• Attend scheduled training for NFB Youth Coordinators;
• Identify and participate in mentoring trainings with organizations such as those identified on ;
• Use materials and consultation provided by the NCME as needed;
• Work cooperatively with an advisory board and the affiliate president to develop specific plans for implementation of the mentoring program in the respective state;
• Develop and maintain a positive working relationship with agencies, schools, universities, and consumer organizations of the blind, both at the local and state level;
• Promote and publicize the Mentoring Program within the state;
• Recruit transition age mentees who are blind or have low-vision and blind mentors;
• Identify and screen potential mentors and mentees based on best practices as outlined in the National Center for Mentoring Excellence Policy and Procedure Manual;
• Provide proof of background check for all mentors accepted into the program;
• Match mentors and mentees;
• Develop and facilitate mentor/mentee training and quarterly regional/statewide activities and events, and generate ideas for mentoring pair activities;
• Monitor the progress towards meeting program goals;
• Monitor the mentoring relationships through monthly contact with mentors and mentees;
• Track and report to affiliate all expenditures related to grant allocation;
• Hold routine teleconferences for mentors and mentees to keep them apprised of activities. It is recommended that mentor and mentee teleconferences are held separately in most cases;
• Work on fundraising for the program, whether it is through grants or activities;
• Develop working relationship with employers in local communities within state for the purpose of job shadowing experiences for youth; and
• Submit all necessary reports to affiliate and state agency.
1.2 Financial Sustainability
Agencies/organizations who administer mentoring programs are responsible for developing a financial plan that may include the following budget items:
• Staff salaries and benefits;
• Operating expenses such as marketing, training, supplies, screening fees, and travel; and
Program activity support such as confidence-building activities, recognition events, food, housing, transportation, and activity allowance for mentors and mentees, etc.
Agencies/organizations are responsible for developing a financial plan with budget projections to sustain the program. It is also the responsibility of the agencies/organizations to identify and secure a diversified stream of funding that does not heavily rely on one source.
1.3 Advisory Committee
The National Center for Mentoring Excellence recommends that the mentoring program is guided by an advisory council. The advisory council could be the board of the affiliate. This committee supplies the expertise, tools, and oversight to advance the mentoring program, and to insure that it continues to effectively meet the needs of blind youth and young adults.
The Advisory Committee should maintain a balanced representation of knowledgeable people from the following areas:
• Mentoring;
• Blindness community;
• Education professionals;
• Rehabilitation professionals;
• Business leaders/employers;
• Blind youth; and
• Parents/youth representatives.
1.4 Types of Mentoring Relationships
For the purpose of the initial demonstration grant program, the primary type of mentoring relationship was traditional (one adult to one young adult). The mentoring pairs committed to spending eight (8) hours face-to-face time. The traditional mentoring relationship is ideal for gaining the trust of a blind young adult, but it may be supported by the following with active participation of the assigned mentor:
• Group mentoring (one adult to up to four young people);
• Team mentoring (several adults working with small groups of young adults, if the adult to youth ratio is no greater than 1:4); and
• E-mentoring, i.e., mentoring via e-mail and the Internet, only in conjunction with any of the above mentoring relationships.
1.5 Location of Mentoring Activities
Mentoring can take place in a wide array of settings. The mentoring relationships will need to occur in settings that will promote the acquisition of experiences that will build confidence, increase knowledge, and encourage personal and career development. It is important when choosing the location of a mentoring activity to remember that the key to mentoring is spending quality time together and building the mentoring relationship, while promoting the Five Essential Elements for Success for blind people as outlined in Section 3.6.4 of this manual.
This manual has been developed as the result of a five-year grant from the U.S. Department of Education, Office of Special Education and Rehabilitative Services, Rehabilitation Services Administration and has been adapted from the sample National Mentoring Center Policy and Procedure Manual.
SECTION 2: Policies
The following policies will guide the coordination and execution of all program activities.
2.1 Eligibility
2.2 Recruitment
2.3 Inquiry
2.4 Screening
2.5 Transportation
2.6 Overnight Visits and Out-of-town Travel
2.7 Training
2.7.1 Training and Activity Evaluations
2.8 Matching
2.9 Support and Supervision
2.10 Confidentiality
2.11 Record-keeping
2.12 Mandatory Reporting
2.13 Use of Alcohol, Drugs, and Firearms
2.14 Unacceptable Behavior
2.15 Recognition
2.16 Closure
2.17 Evaluation
2.1 Eligibility Policy
All participants must meet the defined eligibility criteria. Mentoring staff should be knowledgeable of and understand all eligibility criteria required for mentor and mentee participation in the program.
Mentor Eligibility Requirements
A mentor must:
• Be legally blind or low vision;
• Demonstrate attitude/perspective that is consistent with the NCME mission;
• Demonstrate competence in daily living skills;
• Demonstrate success in a career/steps towards attaining a successful career;
• Reside in the state of the mentoring program in which he or she is applying—unless otherwise approved by the mentoring program staff;
• Have access to reliable transportation;
• Have a clean criminal history; and
• Have never been accused, arrested, charged, or convicted of abuse or molestation.
A mentor must agree to:
• Make a two-year commitment to the program;
• Meet with mentee face-to-face for a minimum eight hours per month;
• Communicate weekly with mentee either by telephone, email, or instant messaging (IM);
• Attend required mentor orientation and trainings;
• Participate in required mentor teleconference;
• Participate in planned individual and group activities;
• Communicate regularly with the State Coordinator; and
• Submit reports as required by the program.
A mentor must not:
• Have been convicted of a felony;
• Have been convicted of the use of illicit drugs;
• Use alcohol or controlled substances in an excessive or inappropriate manner;
• Currently be in treatment for substance abuse. If a substance abuse problem has occurred in the past, the applicant must have completed a non-addictive period of at least five years;
• Currently be under treatment for a mental disorder or have been hospitalized for a mental disorder in the past three years; and
• Have falsified information during the course of the screening process.
Mentee Eligibility Requirements
A mentee must:
• Be legally blind or low vision;
• Be at transition age at the time of application;
• Reside in the state of the mentoring program in which he or she is applying--unless otherwise approved by the mentoring program staff;
• Enter and be willing to participate in the program voluntarily;
• Agree to abide by all policies and procedures; and
• Obtain parental approval for participation in the program (if under the age of 18).
Expectations for Participation
A mentee must agree to:
• A two-year commitment to the program;
• Complete screening procedure;
• Commit to a meet face-to-face with your mentor monthly for a minimum of eight hours;
• Communicate weekly with his/her mentor either by telephone, e-mail, or instant message (IM);
• Attend required mentee orientation and trainings;
• Participate in planned individual and group activities;
• Communicate regularly with the State Coordinator;
• Submit required reports;
• Apply for state Vocational Rehabilitation services; and
• Participate in mentee teleconferences.
2. Recruitment Policy
Recruitment for new mentors is an ongoing activity. As such, an Annual Recruitment Plan (Section 3.1) will be developed and will include recruitment goals, strategies to achieve these goals, an annual timeline, and budgetary implications. This plan will be kept current with ongoing adjustments.
The State Coordinator assumes lead responsibility for the recruitment of new mentors. The host agency/organization staff, state affiliates president, and advisory board members will support the State Coordinator in these activities as required.
2.3 Inquiry Policy
Excellent public relations and customer service must be provided to all potential program participants at all times, from first contact throughout the screening process and beyond, regardless of the final screening outcome. All program staff handling calls from prospective mentors must be patient, courteous, and respectful in all interactions. When the State Coordinator or a program staff member receives an inquiry from a potential referral source or participant, the name of the participant and contact information will be recorded and tracked.
All inquiries regarding participation in the mentoring program are to be responded to within one business day by the State Coordinator. The State Coordinator will respond to all inquiries either by personal contact, telephone, or e-mail.
Confidentiality (Section 2.10) for all potential participants will be upheld from this initial point of contact forward.
2.4 Screening Policy
All mentor and mentee applicants must complete the following screening requirements.
Requirements for Mentor Screening:
• Complete mentor application process as outlined in Section 3.3;
• Submit to a thorough background check: In partnership with the FBI, MENTOR/National Mentoring Partnership is pleased to make nationwide FBI fingerprint-based background checks available to any mentoring program in the country. Through SafetyNET, , each FBI background check costs $18, and results are delivered within 3-5 business days; and
• Complete personal interview with State Coordinator.
Requirements for Mentee Screening:
• Complete mentee application process as outlined in Section 3.4;
• Obtain parent/guardian consent (if appropriate); and
• Complete personal (mentee) interview.
The decision to accept an applicant into the program will be based upon a final assessment done by the State Coordinator at the completion of the mentor or mentee screening procedure. The State Coordinator has final approval for an applicant’s acceptance into the program. Reasons for acceptance/rejection for the program will not be disclosed to anyone, except as appropriate under the rules of confidentiality.
Documentation of screening process must be maintained for each applicant and placed in confidential files.
2.5 Transportation Policy
Mentors are allowed to transport mentees in their own private vehicles or by using leased services with a hired driver. The program coordinator must ensure that all mentors and drivers meet the following criteria prior to transporting the mentee:
• All mentors must have access to reliable, insured transportation; all safety equipment including blinkers, lights, brake and back-up lights, seat belts, tires, and brakes must be in good operating condition;
• All drivers must possess a valid driver’s license and present proof of auto insurance;
• All drivers for mentors are required to obey all traffic laws and use seat belts and headlights at all times;
• If an accident occurs while the mentor is engaged in mentoring, it should be reported to the State Coordinator promptly; and
• The mentor must carry a copy of the mentee’s (if under the age of 18) health insurance information in the transporting automobile at all times in case of emergency.
If any of the above policy is not followed, the mentor will not be allowed to transport the mentee in a private automobile.
6. Overnight Visits and Out-of-town Travel Policy
We encourage mentor/mentee visits within the home community of the mentee and recommend overnight visits using the following guidelines:
• Overnight visits and out-of-town travel for mentees under the age of eighteen are only permitted with approval in writing from both the State Coordinator and parent/guardian.
• For any and all admissible out-of-town travel, the parent/guardian must write and sign a permission slip stipulating:
o The child is permitted to travel with the mentor to the predetermined destination, specifying names and the location(s) being traveled to.
o Permission for medical treatment in case of a medical emergency.
• For out-of town trips lasting more than one day, the mentor must check in with the parent/guardian daily by phone.
• During permissible out-of town travel, the mentor should review and abide by all terms outlined in the transportation policy.
2.7 Training Policy
All mentors and mentees must attend an initial training session, which will be conducted before beginning the mentoring relationship. The agendas must cover basic program guidelines such as: confidentiality; roles and responsibilities of mentor and mentees; mandatory reporting; communication/relationship building skills; and the Five Essential Elements for Success (Section 3.6.4).
Each mentor and mentee will attend at least two in-service training sessions per year. These in-service sessions will be scheduled and arranged by the State Coordinator.
It is the responsibility of the State Coordinator to plan, develop, and deliver all training sessions, with the assistance of agency staff, and volunteers (i.e., former mentors and mentees, experts in the field of mentoring, leaders in the blindness community, etc.).
2.7.1 Training and Activity Evaluations
All planned trainings and activities will conclude with an opportunity for participants (i.e., mentors, mentees, parents, and program staff) to evaluate the effectiveness of the training or activity. Evaluations will be available in alternative formats at the time of the training or activity. (see Section 3.6.3 for NCME Evaluation Form).
2.8 Matching Policy
The State Coordinator will follow the guidelines outlined in the Matching Procedure before creating a mentor/mentee match (see Section 3.5). The State Coordinator should use the factors outlined in the Matching Procedure to determine the suitability of a mentor/mentee match.
The State Coordinator will determine the suitability based on the following criteria:
• Preferences of the mentor, mentee, and/or parent/guardian (if appropriate);
• Gender;
• Common interests
• Geographic proximity;
• Similar personalities; and
• Needs of the mentee (career/personal).
Matches must be either male adult to male youth/young adult or female adult to female youth/young adult. Under special circumstances, exceptions to this rule will only be made in consultation with the affiliate president and the advisory board.
2.9 Support and Supervision Policy
During the initial phase (3-6 months), the State Coordinator will make weekly phone or personal contact with all parties to each match, including mentor, mentee, and parent/guardian (if appropriate). The State Coordinator must gather information for that month, including the dates and times spent participating in mentoring activities and a description of those activities, and assess the success of the match from all parties’ perspectives. In the case of match difficulties, discord, or concerns, appropriate discussion and intervention must be undertaken to improve and rectify problem areas. All mentors and mentees must be provided with reliable contact information for the State Coordinator, and all calls and inquiries from mentors and mentees must receive a response within twenty-four hours.
Mentoring program staff must follow the steps outlined in the Match Support and Supervision Procedure (Section 3.7). Beyond monitoring the match relationship and activities, program staff must undertake other efforts that support participants, such as regular group activities for matches and a formal support structure for mentors.
2.10 Confidentiality Policy
It is the responsibility of the mentoring program to protect the confidentiality of its participants and their families. With the exception of the limitations listed below, program staff will only share information about mentors, mentees, and their families with other program and agency/organizational staff on a need-to-know basis. The State Coordinator will consider whether the information, reports, or summary documents requested by other agency/organizational staff should be released, and whether the information is necessary for the purpose of the requesting program. Further, all prospective mentors, mentees, and parents/guardians should be informed of the scope and limitations of confidentiality by the State Coordinator. Additionally, mentors and mentees are required to keep information about mentoring participants and their families confidential.
In order for the mentoring program to provide a responsible and professional service to participants, it is necessary to ask mentors, mentees, parents/guardians, and other outside sources to divulge personal information about the prospective participants and their families, including:
• Information gained from mentors and mentees, written or otherwise, about themselves and/or their families, in application to and during program participation;
• Participant’s names and images gained from participants themselves, program meetings, training sessions, and other events; and
• Information gained about participants from outside sources including confidential references, school staff (if appropriate), and background checks.
Records are, therefore, considered the property of the mentoring program, not the mentoring program workers, and are not available for review by mentors, mentees, or parents/guardians.
limits of Confidentiality:
Information from mentor and mentee records may be shared with individuals or organizations as specified below under the following conditions:
• Information may be gathered about program participants and shared with other participants, individuals, or organizations only upon receipt of signed “release” forms from mentors, mentees, or parents/guardians.
• Identifying information (including names, photographs, videos, etc.) of program participants may not be used in agency/organizational publications or promotional materials without written consent (Section 3.2).
• Information about program participants, performance, activities, and outcomes may be used without signed consent, provided that the information contains no identifying information, and can in no way be traced back to the mentor, mentee, or other participants.
• Information may only be provided to law enforcement officials or the courts pursuant to a valid and enforceable subpoena.
• Information may be provided to legal counsel in the event of litigation or potential litigation involving the agency/organization. Such information is considered privileged information, and its confidentiality is protected by law.
• Program staff and mentors are mandatory reporters and as such must disclose information indicating that a mentor or mentee may be dangerous or intend to harm him/her self or others. Specific training related to mandatory reporting will be provided at the mentor training.
• If program staff receive information at any point in the match process that a mentor volunteer is using illegal substances, that there is a criminal history of any kind, or that the mentor is inappropriately using alcohol or other controlled substances, the information will be shared with the mentee and the parent (if appropriate) and the mentee and/or the parent (if appropriate) will have the option to reject the prospective mentor or close the existing match.
• At the time a mentor or mentee is considered as a match candidate, information is shared between the prospective match parties. However, the full identity of the prospective match mate shall not be revealed at this stage. Names and addresses are shared with match mates only after the involved parties have met and agree to be formally matched. Each party shall have the right to refuse the proposed match based on the anonymous information listed below provided to them. The information to be shared may include:
o Mentors: age, gender, race, religion, interests, hobbies, employment, living situation, reasons for applying to the program, and a summary of why the individual was chosen for the particular match.
o Mentees: age, gender, race, religion, interests, hobbies, family arrangement, living situation, a summary of the client needs assessment, and expectations for match participation.
Safekeeping of Confidential Records
The State Coordinator is considered the custodian of confidential records. It is his/her responsibility to supervise the management of confidential information in order to ensure safekeeping, accuracy, accountability, and compliance with the mentoring program policies as well as the policies of the host agency.
Requesting Confidential Information from Other Agencies
Program staff shall respect a mentee’s or mentor volunteer’s right to privacy. Requests for confidential information from other organizations, agencies, or persons shall be accompanied by a signed release from the mentor, mentee, and/or parent/guardian, and may only be requested if the information is directly related to the successful execution of the mentoring program.
Violations of Confidentiality
A known violation of the agency policy on confidentiality by a program participant (staff, mentor, and/or mentee) may result in a written warning or disciplinary action such as suspension or termination from the program.
2.11 Record-Keeping Policy
Each step of the mentoring application and match process must be documented by creating a case file for each potential mentor and mentee. All forms for managing mentor and mentee case files are included within the procedures section of this manual (Section 3.4).
All records are to be kept confidential and are to be covered by the conditions outlined in the confidentiality policy. Archival records or those records of past applicants and participants will be maintained and kept confidential for a period of five years after the close of their participation in the program. After five years, the records will be shredded and discarded and destroyed only by approved individuals.
The State Coordinator must keep comprehensive records of all program activities. The records should include the date of activities, number of participants (to include the number of mentors, mentees, parents/guardians, agency, or organizational staff), number of hours of training, cost per participant and brief description of activity. All files should be regularly maintained and updated within an electronic database and/or hard-copy filing system.
2.12 Mandatory Reporting Policy
All staff, mentors, and other representatives of the program must report any suspected abuse and/or neglect of program participants immediately. All such suspected reports must be reported to the appropriate state and/or local authorities that represent Health and Human Services. Program staff must follow the mandatory reporting of abuse and neglect procedure (Section 3.9).
All employees, volunteers, and mentors of the mentoring program are required to undergo training as to what constitutes abuse and neglect, what the state statutes are, and how to properly report such cases.
Any staff, volunteer, or mentor accused of abuse or neglect will be investigated by the mentoring program. Contact with program youth will be restricted or constrained and/or the person in question suspended from employment or program participation per the decision of the State Coordinator, advisory board, and affiliate president who supervises the mentoring program.
2.13 Use of Alcohol, Drugs, and Firearms Policy
All mentees and mentors are prohibited from using drugs or alcohol* or possessing firearms while engaged in the mentoring relationship. Any suspected violations must be reported to the State Coordinator.
*Mentoring pairs in which the mentee is over the age of 21 may consume alcohol in social situations as long as a two drink maximum is not exceeded.
The possession or use of firearms, explosives, toxic or dangerous chemicals, or other lethal weapons, equipment, or material while participating in mentoring activities is strictly prohibited.
Any violation of this policy will result in the immediate suspension and/or termination of the mentoring relationship. In addition, violations of this policy may result in notification being given to legal authorities that may result in arrest or legal action, and may be punishable by fine and/or imprisonment.
2.14 Unacceptable Behavior Policy
Unacceptable behavior will not be tolerated on the part of mentors or mentees while participating in the program. This policy is in addition to behavioral requirements stipulated in other policies or procedures within this manual. This policy in no way is intended to replace or take precedence over other policies or procedures including, but not limited to, the following:
• Confidentiality Policy;
• Transportation Policy;
• Overnight Visits and Out-of-town Travel Policy;
• Mandatory Reporting Abuse and Neglect Policy; and
• Use of Alcohol, Drugs, and Firearms Policy.
A number of behaviors are regarded as incompatible with mentoring program goals, values, and program standards and therefore are considered unacceptable and are strictly prohibited, and may be pursuant to legal action:
• Unwelcome physical contact, such as inappropriate touching, patting, pinching, punching, and physical assault
• Unwelcome physical, verbal, visual, or behavioral mannerisms or conduct that denigrates, shows hostility or aversion toward any individual or group
• Demeaning or exploitive behavior of either a sexual or nonsexual nature, including threats of such behavior
• Display of demeaning, suggestive, or pornographic material
• Known sexual abuse or neglect
• Denigration, public or private, of any mentee parent/guardian or family member
• Denigration, public or private, of political or religious institutions or their leaders
• Intentional violation of any local, state, or federal law
• Using a driver who is drinking or under the influence of alcohol while driving
• Possession of illegal substances
• Imposing religious or moral values onto mentee
Any unacceptable behavior, as specified but not limited to the above, will result in a warning and/or disciplinary action, including suspension or termination from participation in the mentoring program.
2.15 Recognition Policy
All participants—including mentors, mentees, and parents/guardians (if appropriate)—are to be recognized as important to the success of the mentoring program. Particular emphasis will be placed upon recognizing the program volunteers or mentors.
It is the responsibility of the State Coordinators to, at minimum, plan and implement the following recognition activities:
• Host an annual recognition event, including selection of a mentor and mentee with outstanding service or performance acknowledgements;
• Feature a mentor, mentee, parent/guardian, or a general match success story annually in an appropriate publication such as the affiliate newsletter, Braille Monitor or Future Reflections; and
• Establish a mentor recognition award system for length of service.
Utilize outstanding mentors to help deliver orientation and training sessions for the recruitment and matching of new mentors.
2.16 Closure Policy
All mentors and mentees must participate in closure procedures when their match relationship ends. Closure is defined as the ending of a formal match relationship regardless of the circumstances surrounding the ending of the match or whether the parties intend to have future contact informally beyond the match duration.
Closure can occur for any number of reasons, including: the contracted match duration has ended, one or both participants do not want to continue the match, there are changes in life circumstances in one or both of the match partners’ lives, or an individual no longer meets the requirements for program participation. Hence, the match may end at the discretion of the mentor, mentee, parent/guardian (if appropriate), and/or State Coordinator. It is left to the discretion of the State Coordinator whether an individual will be reassigned to another match in the future based upon past participation performance and current goals and needs of the program.
2.17 Evaluation Policy
The National Center for Mentoring Excellence used mentor and mentee reports, training and activity evaluations, interviews of participants, and an external evaluation to evaluate the mentoring programs which participated in the demonstration grant. These tools were effective in gathering the information that was needed to change the program and improve it. Some of the information gathered was used to revise this manual to make the program run even more smoothly for future participants. Evaluations and reports about the program should also be used as a tool to secure additional funding, and to report to stakeholders and current funders about the progress of the program. Most importantly, reports are indicators of the effectiveness of the mentoring program for the participants.
As such, it is critical that Program Coordinators collect data about program participants and activities in a systematic and routine fashion. The data collected serves the dual purpose of providing information to the Coordinators about what areas of the program need attention or modification and providing information to the affiliate on the overall efficient and effective operation of the mentoring program.
Data that must be collected by Program Coordinators come in many forms and will be both qualitative and quantitative in nature. Coordinators should use due diligence in maintaining current contact information, records, and reports on the activities of mentors and mentees. Additionally, monthly reports provide information on the amount and quality of contact occurring in the matched pairs. Quarterly reports serve to provide an indication to the State Coordinator as to how well the match is working for the pairs. Finally, workshop evaluations and interviews with program participants provide information about scheduled trainings and activities, which provides information needed for mid-course corrections. These various pieces of data are critical for the State Coordinator to adequately monitor the operation of the mentoring program.
Section 3.0: PROGRAM OPERATIONS AND PROCEDURES
Program procedures outline the general steps that need to be followed to implement the many components of your mentoring program.
3.1 Recruitment Procedure
Annual Mentor/Mentee Recruitment Plan
Semi-monthly Recruitment Activity Plan
2. Inquiry Procedure
Mentor Job Description
Mentor Application
Information Release
Mentor Interest Survey
Photographic Release
Mentee Referral
Mentee Application for Minors
Mentee Application
Mentee Interest Survey
3.3 Mentor Screening Procedure
Mentor Contact Sheet
Mentor Assessment Summary
Mentor Interview Form
Personal Reference Interview
Mentor Acceptance Letter
Mentor Rejection Letter
3.4 Mentee Screening Procedure
Mentee Screening Procedure
Mentee Contact Sheet
Mentee Assessment Summary
Mentee Interview Form
Mentee or Mentee/Parent Acceptance Letter
Mentee Rejection Letter
3.5 Matching Procedure
Mentor Contract
Mentee Contract
Parent/Guardian Contract
3.6 Training Procedure
3.6.1 General Training Procedures
3.6.2 Initial Training Session
3.6.3 Mentoring Training/Activities
Training and Activity Evaluation Form
4. Five Essential Elements for Success
3.7 Match Support and Supervision Procedure
3.7.1 Supervision
3.7.2 Problem Resolution
3.8 Recognition Procedure
3.9 Mandatory Reporting of Abuse and Neglect Procedure
Abuse and Neglect Report
3.10 Closure Procedure
Match Closure Summary
Mentor Exit Survey
Mentee Exit Survey
Parent/Guardian Exit Survey
Closure Letter
Section 4.0: Evaluation Procedure
3.1 Recruitment Procedure
Annual Mentor/Mentee Recruitment Plan
Semi-monthly Recruitment Activity Plan
Recruitment Procedure:
1. The State Coordinator will develop mentor and mentee recruiting packets as follows:
• Mentor recruiting packet will include a program brochure, Mentor Job Description, Mentor Application, Mentor Interest Survey, Information Release, Photographic Release, and contact information for the Program Coordinator.
• Mentee recruiting packet will include a program brochure, Mentee Application, Mentee Interest Survey, Referral form, Photographic Release, and contact information for the Program Coordinator.
The packets are to be disseminated in an alternative format to all applicants. The printed documents, once completed, initialed, and signed as indicated, are to be mailed to the State Coordinator for the state in which he or she is applying.
2. Key agency/organization staff members receive training on the principles of mentor/mentee recruitment and have a working knowledge of the mentoring program’s recruitment plan.
3. The State Coordinator will take the lead in developing an Annual Recruitment Activity Plan with input from key staff that will be involved in assisting with recruitment. Planning should be finalized by six months before the program begins, so that active recruiting can take place well in advance of the program start date.
4. The State Coordinator will develop a detailed Semi-monthly Recruitment Activity Plan of specific tasks, roles, and responsibilities, incorporating key staff necessary to implement specific recruitment activities.
5. The State Coordinator is responsible for ensuring implementation of the Annual Mentor/Mentee Recruitment and Semi-monthly Recruitment Activity Plans.
6. The State Coordinator will perform a recruitment plan review before development of the next semi-monthly plan including the input from key agency/organization staff or others of concern.
7. The State Coordinator will finalize and distribute the quarterly Recruitment Activity Plan to the affiliate president and the advisory committee.
8. The State Coordinator will summarize the Volunteer Inquiry Tracking log (Section 3.2) and provide the results to the affiliate president on a monthly basis.
9. The affiliate president will provide the yearly budget for recruitment and marketing activities. The State Coordinator is responsible for tracking and monitoring expenditures.
10. Based on tracking data and the overall effectiveness of the recruiting efforts, staff will revise the strategy as needed.
Annual Mentor/Mentee Recruitment Plan
Recruitment Objective
Mentor: Attract 25 new blind adult mentors by [date]
Mentee: Attract 20 new blind or low-vision youth by [date]
Note: The numbers are suggestions, and the goal number of mentors and mentees depends on the size of the affiliate. It is important to attract as many or more mentors as mentees in case the mentors aren’t compatible with mentees. Through our demonstration grant, we discovered that more importantly than the quantity of pairs was the quality of the mentoring relationships. Many of our programs started out the two years with 20 mentoring pairs and ended up with 10-15 quality relationships that lasted for the full two years.
Target Audience
Mentor: Blind men and women, with an emphasis on (increasing the number of minority mentors or people in a specific area. The target audience will depend on the needs of your program and should be addressed accordingly).
Mentee: Blind and low-vision youth and young adults with an emphasis on (increasing the number of minority mentees, or people in a specific area).
Positioning Statement or Core Communication Message
This is essentially our elevator speech, a quick message that can be used when promoting the mentoring program. “Helping blind youth and young adults develop the blindness skills and positive attitudes necessary to lead a life of success and accomplishment.”
Promotional Materials
• Program Brochure
• Press release
• The National Center for Mentoring Excellence DVD, “Walking the Walk: The NFB Mentorship Advantage” that can be found on mentoring
• Generic news article—for newsletters, papers, and local magazines
• Program presentation with overheads, notes, and handouts
• Web site development
Promotional Activities
• Monthly contact with vocational rehabilitation counselors throughout the state with a minimum goal of contacting each counselor twice per year
• Quarterly contact with consumer organizations of the blind
• Place brochure and flyer throughout the community—continuously
• Display tables at local events—as available
• Distribute press release and PSA to local media—quarterly
• Make personal contact with key media and organization leaders—2 or 3 per month
• Present to community organizations 1–2 times per month
• Gather inquiries from Web site and e-mail (online interest submission)—continuously
Target Organizations
• Governmental Agencies
• Consumer Organizations of the Blind
• State Vocational Rehabilitation
• Professional Associations
• High Schools
• State Special Education Departments
• Local Colleges
• Local Businesses
• Churches/Faith-Based Groups
• State and Regional Libraries for the Blind (NLS)
Semi-monthly Recruitment Activity Plan
(Sample)
Activity:
Tasks
Persons Responsible
Date Complete:
Promotional Material Development:
Press Release
State Coordinator
Date Complete:
Web Site Update
State Coordinator
Date Complete:
Newsletter
State Coordinator
Date Complete:
Promotional Activities:
Inquiry Responses–Web, Phone, and E-mail
State Coordinator
Date Complete:
Mail-out First Quarter Newsletter Submission
State Coordinator
Date Complete:
Distribute Brochures and Application Packets
State Coordinator and other staff
Date Complete:
Mentor Orientation Session–TBD by State Coordinator
State Coordinator
Date Complete:
Contact Rotary–Request to Speak at Q2 Meeting
State Coordinator
Date Complete:
Meeting/Presentation
State Coordinator and Other Staff
Date Complete:
Chamber Luncheon Speech
State Coordinator
Date Complete:
Radio Interview
State Coordinator
Date Complete:
2. Inquiry Procedure
Mentor Job Description
Mentor Application
Information Release
Mentor Interest Survey
Photographic Release
Mentee Referral
Mentee Application for Minors
Mentee Application
Mentee Interest Survey
All persons inquiring about becoming program participants or making referrals regarding potential mentees must speak directly to the State Coordinator of mentoring. If the State Coordinator is unavailable, other organization/agency staff should courteously take a message and inform inquirers they will be contacted within a day by the State Coordinator.
The State Coordinator should follow the inquiry procedure as outlined below:
1. All prospective mentor inquiries will be recorded on a Volunteer Inquiry Tracking form, including how the person heard about the program. The Volunteer Inquiry Tracking form will include the following headings: Name of person inquiring, Date contacted (phone, e-mail, fax), How he/she found out about the program, and Date of follow up
2. All mentor and mentee inquiries regarding participation in the program must be answered within two business days.
3. Program staff provides a verbal overview of the program to all phone and in-person inquiries, adjusting the message to address potential mentors or mentees:
• Overview of program and program purpose
• Time and duration commitments
• Overview screening requirements
• Training requirements
• Completing an application
4. All prospective participants requesting to learn more and/or wanting to complete the application process will receive the following materials in person or by mail:
Mentor recruiting packet will include:
• Program brochure
• Mentor Job Description
• Mentor Application
• Mentor Interest Survey
• Information Release
• Photographic Release
• Program Coordinator contact information
Mentee recruiting packet will include:
• Program brochure
• Mentee Application
• Mentee Interest Survey
• Referral form
• Photographic Release
• Program Coordinator contact information
5. All applicants will be informed of the upcoming mentor and mentee
orientation.
The State Coordinator will conduct separate mentor and mentee orientation sessions, either individually, in small groups, or via teleconference, to provide detailed information about the program. Orientation sessions are held primarily to create interest among prospective participants and to address any concerns they may have about the program.
Referral Forms
Referral forms are provided so that teachers, rehabilitation counselors, and other referral sources may provide basic information for potential mentee referrals.
Referral forms, once complete, are to be returned to the State Coordinator, logged as an inquiry, and followed up on, as with all inquiries.
Prospective participants who have submitted an application, received an overview of the mentoring program, and are interested and willing to make the required commitment may then complete the screening procedure.
Mentor Job Description
The mission of the National Center for Mentoring Excellence is to link transition age blind and low-vision youth with successful blind mentors for the purpose of increasing knowledge and participation in the vocational rehabilitation process, post-secondary academic success, high-quality employment, and community integration.
The mentoring program uses adult blind volunteers to commit to supporting, guiding, and empowering blind young adults for a period of two years. By becoming part of the social network of blind adults and community members who care, the mentor can help blind young adults develop and reach positive academic, career, and personal goals.
Mentor Role
• Take the lead in supporting a blind young adult through an ongoing, one-to-one relationship
• Serve as a positive blind role model and friend
• Instill the Five Essential Elements for Success (section 3.4.6)
• Build the mentoring relationship by planning and participating in activities together
• Strive for mutual respect
• Build self-esteem, motivation, and confidence in the blind young adult
• Help set goals and work toward accomplishing them
Time Commitment
• Make a two-year commitment
• Spend a minimum of eight hours per month meeting one-to-one with mentee
• Communicate with the mentee weekly either through telephone contact, e-mail, or Instant Messaging (IM)
• Attend mentor training session
• Attend mentor/mentee group events, mentor support groups, and program recognition events
Participation Requirements
• Be legally blind
• Possess a positive attitude about blindness
• Demonstrate good blindness skills or understand the importance of developing good blindness skills
• Be or have been successful in chosen career or in the process of pursuing a career
• Be at least 21 years old
• Reside in the state of the mentoring program to which you are applying
• Be interested in working with blind youth or young adults
• Be willing to adhere to all program policies and procedures
• Be willing to complete the application and screening process
• Be dependable and consistent in meeting the time commitments
• Attend mentor training sessions as prescribed
• Be willing to communicate regularly with program staff, submit activity information, and take constructive feedback regarding mentoring activities
• Complete required reports assigned by the program coordinator
• Participate in routine conference calls with mentors from across the state
• Have access to reliable transportation
• Have a clean criminal history
• Not use illicit drugs
• Not use alcohol or controlled substances in an inappropriate manner
• Not be currently in treatment for substance abuse and have a non-addictive period of at least five years
• Not be currently in treatment for a mental disorder or hospitalized for such in the past three years
Desirable Qualities
• Willing listener
• Encouraging and supportive
• Patient and flexible
• Tolerant and respectful of individual differences
Benefits
• Personal fulfillment through contribution to community and individuals
• Satisfaction in helping someone mature, progress, and achieve goals
• Training sessions and group activities with other blind mentoring pairs
• Participation in a mentor support group
• Mileage and expenses are tax deductible for non reimbursed expenses
• Personal ongoing support, supervision to help the match succeed
Application and Screening Process
• Complete application
• Federal Bureau of Investigation criminal history check
• Personal interview
• Provide three personal references
• Attend mentor orientation
For more information, contact: [insert State Coordinator contact information]
Mentor Application
Name (first, middle, last):
Street address:
City:
State:
ZIP:
County/Parish:
Primary phone number:
Alternate phone number:
E-mail address:
What is the best day/time to contact you by phone, and at which number do you prefer to be reached?
Date of birth (mm/dd/yyyy):
Please mark an X next to the appropriate items below:
___ Male
___ Female
With which of the following ethnic groups do you most closely identify?
___ African American, Black
___ Asian American, Asian
___ Caucasian, White
___ Native American
___ Hispanic, Latino
___ Other, please specify:
Employment history (list most recent first)
Employer 1:
Title:
Employment dates:
Describe your work:
Reason for leaving:
Employer 2:
Title:
Employment dates:
Describe your work:
Reason for leaving:
Employer 3:
Title:
Employment dates:
Describe your work:
Reason for leaving:
References
Name 1:
Phone:
Alternate phone:
Relationship:
Name 2:
Phone:
Alternate phone:
Relationship:
Name 3:
Phone:
Alternate phone:
Relationship:
1) What is the cause of your blindness or low vision (e.g., Glaucoma, Retinitis Pigmentosa, ROP, etc.)?
2) What is your visual acuity? _______/________
3) Please list your field loss (if any):
4) Please list any additional disability/disabilities (if any):
5) Educational background: Please mark an X to the left of your highest
educational level, or the highest degree you have obtained:
___ Less than high school diploma
___ GED high school equivalency
___ High school diploma
___ Some college or Associates degree
___ Vocational college (graduate)
___ Undergraduate college degree
___ Graduate degree
___ Postgraduate degree (such as doctoral)
6) Please list the highest degree you have obtained and/or license you hold:
7) Please mark an X next to the category that most closely identifies your
primary occupation/activity:
___ Attending college
___ Employed
___ Retired
___ Other, please describe
8) Please list all organizations with which you are currently affiliated and active. Please be sure to include civic, community, social, etc.
9) Is there anyone you would recommend as a possible blind or low-vision
mentor? If so, please provide his or her name and contact information:
Please initial each of the following:
_______ I agree to follow all mentoring program guidelines and understand that any violation will result in suspension and/or termination of the mentoring relationship.
_______ I understand that the mentoring program is not obligated to provide a reason for their decision in accepting or rejecting me as a mentor.
_______ (optional) I agree to allow the mentoring program to use any photographic image of me taken while participating in the mentoring program. These images may be used in promotions or other related marketing materials.
I understand that I must return all of the following completed items along with this signed application and that any incomplete information will result in the delay of my application being processed:
• Information Release Form
• Interest Survey Form
By signing below, I attest to the truthfulness of all information listed on this application and agree to all the above terms and conditions.
_____________________________________________ ________________
Signature Date
Please return or mail this application and the items listed above to: (insert State Coordinator contact information here.)
Information Release
I, _________________________________________, understand it will be necessary for the mentoring program to conduct a background check regarding my criminal history, personal references, and employment.
I authorize the [name of program] to obtain a Federal Bureau of Investigation background check and personal references for the purposes of my participating in a mentoring program.
____________________________________________ _______________
Signature Date
Full Name_______________________________________________________
Address_______________________ City_____________ State____ ZIP_____
Date of Birth ______/_____/________
Social Security Number________/_______/________
Mentor Interest Survey
(To Be Completed by Mentor)
Name: ________________________________________ Date: __________
As a participant in this mentoring program, we would like to know more about your hobbies and interests. The information you provide will assist us in finding a good match for you. Please complete the following survey and return with your completed and signed application.
What are the most convenient times for you to meet with your mentee? Please check all that apply.
Weekdays: ___ Lunchtime: ___ Afternoons: ___ Evenings: ___
Weekends: ___ Other: ___
Do you speak any languages other than English? If so, which languages?
What are some favorite things you like to do with other people?
What are or were your favorite subjects in school?
What is your job and how did you choose this field?
If you could learn about another job/career, what would it be?
What is one goal you have set for the future?
If you could learn something new, what would it be?
What person do you most admire and why?
Describe your ideal Saturday.
Please check all activities you are interested in:
____ Biking ____ Camping ____ Science
____ Cooking ____ Library ____ Hiking
____ Boating ____ Music ____ Sports
____ Yoga ____ Golf ____ Swimming
____ Gardening ____ Parks ____ Movies
____ Fishing ____ Animals ____ Dining out
____ Board games ____ Shopping ____ Technology
____ Ham radio ____ Dancing ____ Video games
____ Museums
List any other areas of special interest:
Please list any questions that you may have about the mentoring program:
Please return the completed interest survey and signed application to: [insert State Coordinator contact information]
Photographic Release
The National Federation of the Blind often takes photographs and video of children and adults for educational and promotional purposes. These images may be used in printed materials, on our Web site, and in training and promotional videos. We may also send them to the news media.
I give permission to the National Federation of the Blind to use my image or likeness, or those of my child(ren), in materials produced by the NFB for promotional and educational purposes or for any other purpose and in any manner and medium.
Name___________________________________ Date_________________
Signature________________________________ Phone________________
Address________________________________________________________
City___________________________ State____ ZIP Code________________
If under 18, signature of parent/guardian_______________________________
Parent/guardian name (print)________________________________________
Please list your favorite hometown newspaper(s): _______________________
_______________________________________________________________
Mentee Referral
(For use by school and other referral agency staff)
Please provide the following information for any legally blind young adult whom you feel could benefit from participating in the two year mentoring relationship with a successful blind adult.
Name of individual being referred: ____________________________________
Date of birth: _____ Highest academic level completed: ___________________
Referred by: _____________________________Title: ____________________
Phone Number: ___________________ E-mail: _________________________
Why do you feel this young person might benefit from a mentor?
What particular interests or hobbies, either in school or out, do you know of that the young person has?
On a scale of 1–10 (10 being highest), rate the young person’s level of:
___ Independent travel (Orientation and Mobility)
___ Braille literacy skills
___ Acceptance of blindness
___ Activities of daily living
___ Social skills
___ Peer relations
___ Family support
___ Academic performance
___ Attitude about school/education
___ Self-esteem
___ Communication skills
___ Career/vocational knowledge
With what specific subjects or topics, if any, does the young person need assistance?
Additional comments:
Please return completed referral to: [insert State Coordinator contact information]
Mentee Application for Minors
Name (first, middle, last):
Street address:
City:
State:
ZIP:
County/Parish:
Primary phone number:
Alternate phone number:
E-mail address:
What is the best day/time to contact you by phone, and at which number do you prefer to be reached?
Date of birth (mm/dd/yyyy):
Please mark an X next to the appropriate items below:
___ Male
___ Female
With which of the following ethnic groups do you most closely identify?
___ African American, Black
___ Asian American, Asian
___ Caucasian, White
___ Native American
___ Hispanic, Latino
___ Other, please specify:
1) What is the cause of your blindness or low vision (e.g., Glaucoma, Retinitis Pigmentosa, ROP, etc.)?
2) What is your visual acuity? _______/________
3) Please list your field loss (if any):
4) Please list any additional disability/disabilities (if appropriate):
5) Are you currently attending school? ___ Yes ___ No
Please mark an X to the left of the highest level of education you have successfully completed:
___ 10th grade
___ 11th grade
___ 12th grade
___ GED
___ College Freshman
___ College Sophomore
___ College Junior
___ College Senior
___ Graduate or above
Degree completed:
Date graduated:
6) Are you currently employed? If so, who is your employer? Give your job title and a brief summary of your job responsibilities:
7) What is your career goal or career interest?
8) Please list all organizations with which you are currently affiliated and
active. Please be sure to include civic, community, social, etc.
9) Is there anyone you would recommend to participate in this mentoring program? If so, please provide his or her name and contact information:
Please read this carefully before signing:
The [name of program] appreciates your and your parent’s/guardian’s interest in your becoming a mentee. This application is intended as a means of informing and gaining consent for you to participate in the mentoring program.
After receiving this completed application from you, we will evaluate the information and send you a letter letting you know if you have been accepted into the mentoring program. Much of the information you supply in this application packet will be used to match you with an appropriate mentor. Therefore, the mentoring staff may, at times, need to access and share this information with prospective mentors and other parties when it is in the best interest of the match. However, we do not reveal names until there is initial interest from the mentee, parent/guardian, and mentor based first upon anonymous information provided about each other.
If you are under the age of 18, please have your parent or guardian complete the following:
Please initial each of the following if you are granting consent:
_______ I give my informed consent and permission for my child to participate in the [name of program] and its related activities.
_______ I agree to have my child follow all mentoring program guidelines and understand that any violation on my child’s part may result in suspension and/or termination of the mentoring relationship.
_______ I hereby acknowledge that my child will be transported by his/her mentor and/or program staff or representatives while participating in the mentoring program and that such transportation is voluntary and at my own risk.
_______ I release the [program name] of all liability of injury, death, or other damages to me, my child, my family, estate, heirs, or assigns that may result from my child’s participation in the program, including but not limited to transportation, and hold harmless any program mentor, program staff, or other representatives, both collectively and individually, of any injury, physical or emotional, other than where gross negligence has been determined.
_______ (Optional) I agree to allow the mentoring program to use any photographic image of my child while participating in the mentoring program. These images may be used in promotions or other related marketing materials.
________I understand that I must return my child’s completed signed Application and Interest Survey Form to the address provided below, and that any incomplete information will result in the delay of my child’s application being processed.
Please provide the following information related to medical history:
Name of Primary Care Physician: ________________________________
Phone number of Primary Care Physician: _________________________
Medical insurance provider: _____________________________________
Policy number: __________________ Phone number: ________________
Does your son/daughter have any physical problems or limitations?
Is your son/daughter currently receiving treatment for any medical issues?
Is he/she currently on any type of medications? If so, please specify.
Does your son/daughter have any known allergies or adverse reactions to medications? If yes, please describe them below:
Does your son/daughter have any emotional issues or problems right now?
Therapist’s Name: ____________________________________________
By signing below, I attest to the truthfulness of all information listed on this
Application and agree to all the above terms and conditions. I give permission for my child, _________________________, to participate in the [program name].
_____________________________________________ _______________
Parent/guardian signature Date
_____________________________________________
Parent/guardian name (please print)
Address: _____________________________________
City: ________________________ State: ___________ ZIP: _____________
Please return or mail this application and the items listed above to: [insert State Coordinator contact information]
Mentee Application
Name (first, middle, last):
Street address:
City:
State:
ZIP:
County/Parish:
Primary phone number:
Alternate phone number:
E-mail address:
What is the best day/time to contact you by phone, and at which number do you prefer to be reached?
Date of birth (mm/dd/yyyy):
Please mark an X next to the appropriate items below:
___ Male
___ Female
With which of the following ethnic groups do you most closely identify?
___ African American, Black
___ Asian American, Asian
___ Caucasian, White
___ Native American
___ Hispanic, Latino
___ Other, please specify:
1) What is the cause of your blindness or low vision (e.g., Glaucoma, Retinitis Pigmentosa, ROP, etc.)?
2) What is your visual acuity? _______/________
3) Please list your field loss (if any):
4) Please list any additional disability/disabilities (if appropriate):
5) Are you currently attending school? ___ Yes ___ No
Please mark an X to the left of the highest level of education you have successfully completed:
___ 10th grade
___ 11th grade
___ 12th grade
___ GED
___ College Freshman
___ College Sophomore
___ College Junior
___ College Senior
___ Graduate or above
Degree completed:
Date graduated:
6) Are you currently employed? If so, who is your employer? Give your job
title and a brief summary of your job responsibilities:
7) What is your career goal or career interest?
8) Please list all organizations with which you are currently affiliated and
active. Please be sure to include civic, community, social, etc.
9) Is there anyone you would recommend to participate in this mentoring program? If so, please provide his or her name and contact information:
Please read this carefully before signing:
The [program name] appreciates your interest in becoming a mentee.
After receiving this completed application from you, we will evaluate the information and send you a letter letting you know if you have been accepted into the mentoring program. Much of the information you supply in this application packet will be used to match you with an appropriate mentor. Therefore, the mentoring staff at times may need to access and share this information with prospective mentors and other parties when it is in the best interest of the match. However, we do not reveal names until there is initial interest from the mentee, parent/guardian, and mentor based first upon anonymous information provided about each other.
Please initial each of the following if you are granting consent:
_______ I agree to follow all mentoring program guidelines and understand that any violation on my part may result in suspension and/or termination of the mentoring relationship.
_______ I hereby acknowledge that I may be transported by my mentor and/or [program name] program staff or representatives while participating in the mentoring program and that such transportation is voluntary and at my own risk.
_______ I release the National Federation of the Blind, its affiliates, and [insert program name] of all liability of injury, death, or other damages to me, my family, estate, heirs, or assigns that may result from my participation in the program, including but not limited to transportation, and hold harmless any program mentor, program staff, or other representatives, both collectively and individually, of any injury, physical or emotional, other than where gross negligence has been determined.
_______ (Optional) I agree to allow the mentoring program to use any photographic image of me while participating in the mentoring program. These images may be used in promotions or other related marketing materials.
________I understand that I must return my completed signed Application and Interest Survey Form to the address provided below, and that any incomplete information will result in the delay of my application being processed.
By signing below, I attest to the truthfulness of all information listed on this
Application and agree to all the above terms and conditions.
_____________________________________________ ____________
Signature Date
_____________________________________________
Name (please print)
Please return or mail this application and the items listed above to: [insert State Coordinator contact information]
Mentee Interest Survey
(To Be Completed by Mentee)
As a participant in this mentoring program, we would like to know more about your hobbies and interests. The information you provide will assist us in finding a good match for you. Please complete the following survey and return with your completed and signed application.
What are the most convenient times for you to meet with your mentor? Please check all that apply.
Weekdays: ___ Lunchtime: ___ Afternoons: ___ Evenings: ___
Weekends: ___ Other: ___
Do you speak any languages other than English? If so, which languages?
What are some favorite things you like to do with other people?
What are or were your favorite subjects in school?
If you could learn about a job/career, what would it be?
What are your favorite subjects to read about?
What is one goal you have set for the future?
If you could learn something new, what would it be?
What person do you most admire and why?
Describe your ideal Saturday.
Please check all activities you are interested in:
____ Biking ____ Camping ____ Science
____ Cooking ____ Library ____ Hiking
____ Boating ____ Music ____ Sports
____ Yoga ____ Golf ____ Swimming
____ Gardening ____ Parks ____ Movies
____ Fishing ____ Animals ____ Dining out
____ Board games ____ Shopping ____ Technology
____ Ham radio ____ Dancing ____ Video games
____ Museums
List any other areas of special interest:
Please list any questions that you may have about the mentoring program:
Please return the completed interest survey and signed application to: [insert State Coordinator contact information]
3.3 Mentor Screening Procedure
Mentor Contact Sheet
Mentor Assessment Summary
Mentor Interview Form
Personal Reference Interview
Mentor Acceptance Letter
Mentor Rejection Letter
In accordance with the recommended screening procedure of the National Center for Mentoring Excellence, the State Coordinator should complete the steps below to determine if a candidate qualifies to become a mentor.
1. A mentor file should be created for all prospective mentors who return a completed application. The mentor file, in its final state should contain the following:
• Mentor contact sheet, which should contain all contact information for the mentor. All contact with the mentor should be recorded with the date of correspondence.
• Mentor assessment summary
• Mentor application—completed and signed
• Information release form—completed and signed
• Background check results
• Personal reference interview forms—completed for three reference checks
• Mentor Interest Survey—completed
• Mentor Interview form—complete
2. As each component of the screening process is completed, place related documentation into the mentor file, and update the checklist on the Mentor Assessment Summary.
3. Mentoring State Coordinators should do the following for each mentor applicant:
• Upon receipt of a complete and signed Mentor Application, Information Release Form, and Interest Survey, schedule an appointment and conduct an in-person interview with all prospective mentors, using the Mentor Interview Form. It is recommended, that when possible, the interview be conducted in the home of the prospective mentor to gain a better understanding of whether he or she is living the life that is desirable as a role model in the NCME Mentoring Program.
• Once the interview is complete, inform the mentor that he/she has completed the first level of the screening process. Match eligibility is not determined until the mentor interviews have been conducted, personal references have been contacted and checked, and a positive FBI criminal history check have been completed.
• Conduct phone interviews with three personal references, using the Personal Reference Interview form; and
• Process the Federal Bureau of Investigation (FBI) criminal history check*.
* In partnership with the FBI, MENTOR/National Mentoring Partnership is pleased to make nationwide FBI fingerprint-based background checks available to any mentoring program in the country. Through SafetyNET, each FBI background check costs $18, and results are delivered within 3-5 business days. For more information please go to or contact: MENTOR/National Mentoring Partnership, 1600 Duke Street, Suite 300, Alexandria, VA 22314 Telephone—703-224-2200
4. Based on all information gathered above, complete the Mentor Assessment and make a determination as to the appropriateness of the participant’s involvement in the program.
5. Send out an acceptance or rejection letter to the applicant based on the overall assessment of appropriateness.
6. If the applicant is rejected, the applicant’s file should be placed into the file area of ineligible applicants.
7. If the applicant is accepted, the mentor must complete a mandatory mentor training session before being matched with a mentee.
Mentor Contact Sheet
Name of mentor: __________________________ Date of birth: ____________
Home phone: ___________________ Alternate phone: ___________________
E-mail: _________________________________________________________
Mentee name: ___________________________________________________
Date Purpose of contact/note
Mentor Assessment Summary
Name: _______________________________________ Date: _____________
Screening materials
Date sent to applicant:
Date received from applicant:
Date sent to school or agency:
Date item completed:
Written application
Date sent to applicant:
Date received from applicant:
Date item completed:
Information release
Date sent to applicant:
Date received from applicant:
Date item completed:
Mentor Interest survey
Date sent to applicant:
Date received from applicant:
Date item completed:
Result of FBI criminal background check
Date sent to applicant:
Date received from applicant:
Date sent to school or agency:
Date item completed:
Mentor interview
Date item completed:
Personal reference interview
Date item completed:
Personal reference interview
Date item completed:
Personal reference interview
Date item completed:
Acceptance/rejection letter
Date item completed:
Eligibility Criteria:
Does the applicant meet each of the eligibility criteria? Please indicate with a yes or no beside each item.
_____ Legally blind
_____ Possess a positive view of blindness
_____ Demonstrates daily skills of blindness
_____ Resides in (State)
_____ Willing to adhere to program policies and procedures
_____ Agrees to a two-year commitment
_____ Commits to monthly (eight hour minimum) face to face contact with
mentee
_____ Agrees to weekly contact with mentee by telephone or e-mail
_____ Completed screening procedure
_____ Agrees to attend required training sessions
_____ Willing to communicate regularly with State Coordinator and submit
monthly and quarterly reports and activity information
_____ Has reliable transportation
_____ Has a driver with a current driver’s license, insurance, and good driving
record
_____ No prior convictions
_____ Does not use illicit drugs
_____ Does not use alcohol or controlled substances inappropriately
_____ Is not in treatment for substance abuse.
_____ Has had a non-addictive period for at least the past five years
_____ Has not been hospitalized for a mental disorder in past three years
_____ Has not falsified information during screening process
Does the mentor applicant meet all eligibility criteria? Yes ______ No________
If no, are there any mitigating circumstances?
General Assessment Areas
Did the applicant relate appropriately to the program staff during the following steps?
• Initial contact and inquiry
• Orientation
• Interview
Did the applicant complete the screening process with ease and appropriateness?
Are his/her reasons for wanting to be a mentor appropriate?
Is the applicant’s personal and professional life appropriate and stable?
Does the applicant exhibit qualities of open-mindedness, flexibility, and emotional stability?
Does the applicant have experience working with youth?
Did the applicant’s references speak well of him/her?
Does the applicant have appropriate age-related interests and ability?
Overall comments:
Application Status
Date Accepted: ____________Date acceptance letter sent: ________________
Matched: Yes: ____Name of Mentee: ______________________Date: ______
Date Rejected: _____________Date rejection letter sent: _______________
Reason: ________________________________________________________
_______________________________________________________________
Mentor Interview Form
Name: ________________________________ Date: ____________________
Home phone: ___________________ Cell phone: _______________________
Work phone: ____________________ E-mail: __________________________
Address: ____________________________ City: _______________________
County: ________________________State: ___________ ZIP Code:________
Employer: ______________________ Job title: _________________________
Employment dates: _______to _________ Supervisor: ___________________
NOTE: Before starting the interview, emphasize to the applicant the program expectations:
• You are making a two-year commitment to maintain this mentoring
relationship;
• You agree to make monthly face-to-face contact with your mentee;
• You agree to communicate weekly, either by phone or e-mail, with
your mentee; and
• You agree to attend scheduled mentor/mentee workshops and activities.
NOTE: All answers given in this interview will remain confidential.
Mentor Information:
Briefly share with me your views about blindness. In particular, how have you adjusted to living with vision loss, and to what factors do you attribute your success?
What would you say are two or three factors that are necessary for anyone who is blind to be successful in life?
What steps have you taken in your life to ensure that you have the skills and self-confidence to live a normal and independent life?
What was your own childhood like?
Briefly share with me your reasons for wanting to be a mentor.
What previous jobs or life experiences have you had which would help you to be an effective mentor?
What do you believe will be your best strengths as a mentor?
Can you think of any reasons why you might have difficulty being a mentor?
Do you have any experience working with young adults, and if so, how will it help you in working with your mentee?
What types of things do you think young people today need the most help with?
Tell me about your interests/hobbies?
What do you like most or find more satisfying about your interests or hobbies?
Serving as a mentor will be a meaningful and rewarding experience, yet it will require a great deal of your time, energy, and commitment. Do you feel that there are any factors that might prevent you from dedicating the necessary time and energy to meet the needs of the participants in this project?
Mentoring a young person is a big responsibility and can change the lives of both the mentor and the mentee. What do you hope to gain from the experience, and what do you hope the mentee will gain from the relationship?
Do you have any questions about the commitment to meet monthly face-to-face with your mentee and to maintain weekly phone or e-mail contact with your mentee?
Interviewer Comments: This section is not to be completed in front of the potential mentor, but should be answered based on the interview.
Applicant’s appearance:
First impression of applicant:
Will the applicant be able to follow the guidelines of the program?
How well did the applicant answer the questions?
Overall conclusions:
Interviewed by:
Approved (Yes/No):
Reasons:
Match recommendations:
Personal Reference Interview
Applicant name: ________________________________Date: _____________
Interviewed by: ___________________________________________________
Personal reference name: __________________________________________
Personal reference phone number: ___________________________________
Your name has been given to us as a reference for ______________________ (mentor), who has applied to be a mentor in our program. I would like to ask you some questions about him/her, which will be held in absolute confidence; your answers will not be shared or accessible to the applicant. Would you be willing and is this a good time for you to answer a number of questions?
1. How long, and in what capacity, have you known the applicant?
2. How does the applicant relate to people in general?
3. How would you describe the applicant?
4. Do you feel that the applicant would be a good mentor and role model to a blind youth or young adult?
5. Do you think that the applicant relates well to young people?
6. Does the applicant usually keep his/her commitments?
7. Is he/she on time for appointments and events?
8. To your knowledge, has the applicant ever been convicted of a crime?
9. Do you know of any problems or issues that would affect the applicant’s ability to work with blind youth or young adults?
10. Would you feel comfortable allowing the applicant to spend time alone with your teenage child?
11. Do you have any additional comments about the applicant?
Interviewer Comments:
Mentor Acceptance Letter
August 24, 2007
Mr. Jim Biggs
Street Address
City, State ZIP
Dear Mr. Biggs,
Congratulations! On behalf of the (name of your mentoring program), we are happy to inform you of your acceptance as a mentor. Without the enthusiasm of volunteers like you, we would not be able to accomplish our mission of empowering blind youth and young adults to learn the necessary life skills and attitudes to live independent successful lives.
We believe that you have the necessary qualities to meet the needs of blind youth and young adults. We are in the process of locating a mentee match for you. As previously discussed during the application process, by accepting this volunteer position, you agreed to maintain the relationship with your mentee for a period of two years.
We will notify you when we have identified the mentee with whom we believe you will be compatible and provide you with the date and location of the mentor training and the mentoring kick-off. You will meet your mentee at the kick-off. If you have any questions, please feel free to contact me at: (provide contact information for State Coordinator).
Welcome to Mentoring!
Sincerely,
Name
State Coordinator
Name of Mentoring Program
Mentor Rejection Letter
August 24, 2007
Mr. Jim Biggs
Address
City, State ZIP
Dear Mr. Biggs,
Thank you for your interest and application to be a mentor for the (name of your mentoring program). After careful consideration, we regret we were unable to make a suitable match. We appreciate the time you invested in the application process, will continue to search for a compatible match, and will notify you when an appropriate match has been identified. We will keep your application on file.
Thank you again for your time and interest in our program.
Sincerely,
Name
State Coordinator
Name of Mentoring Program
Contact Information
3.4 Mentee Screening Procedure
Mentee Contact Sheet
Mentee Assessment Summary
Mentee Interview Form
Mentee or Mentee/Parent Acceptance Letter
Mentee Rejection Letter
In accordance with the recommended screening procedures of the National Center for Mentoring Excellence Program, mentoring program staff should complete the steps below to determine if a candidate qualifies to become a mentee.
1. Upon receiving a referral for any youth or young adult, program staff must begin the process by contacting the potential mentee or, if appropriate, his/her parent/guardian to schedule a mentee orientation session. Referral may be made to the program website to make application or an application packet may be mailed.
The mentee recruiting packet will include a brochure, Mentee Application, Mentee Interest Survey, Referral form, and contact information for State Coordinator. It is advised that the staff do a follow-up call to the parent/guardian, as appropriate, within 72 hours of mailing the application packet and/or initial contact.
2. The applicant must return all completed materials in the application packet given to him or her during the inquiry process. The application packet consists of: program brochure, Mentee Application, Mentee Interest Survey, Referral form (if being sent to a referral source such as school teacher, guidance counselor, or rehabilitation counselor), and contact information for State Coordinator.
3. A mentee file should be created for all prospective mentees who return a completed application. The mentee file, in its final state, should contain the following: Mentee Contact Sheet (should be kept on top of one side of each file, and all contact with the mentee should be recorded with a corresponding date), Mentee Assessment Summary, completed Mentee Referral form (if appropriate), completed and signed Application with appropriate signatures, Mentee Interest Survey, and Mentee Interview form.
4. As each component of the screening process is completed, place related documentation into the Mentee file and update the checklist on the Mentee Assessment Summary.
5. Mentoring program staff must then make an appointment and conduct an in-person interview with the prospective mentee. If the mentee is under the age of eighteen, parent/guardian permission will need to be obtained. This interview should occur in his or her home to gain a clear understanding of the mentee’s home environment.
6. Based on all information gathered above, complete the Mentee Assessment Summary and make a final determination as to the appropriateness of the participant’s involvement in the program.
7. Send out an acceptance or rejection letter to the mentee or mentee/parent/guardian based on the overall assessment of appropriateness.
8. If applicant is rejected, the applicant’s file should be placed into the file area of ineligible applicants.
Mentee Contact Sheet
Name of mentee: __________________________Date of birth: ____________
Parent/guardian (if appropriate): _____________________________________
Home phone: __________________ Cell phone: ________________________
Parent work phone (if appropriate): ___________________________________
E-mail: _________________________________________________________
Mentor name: ____________________________________________________
Date/purpose of contact/notes
Mentee Assessment Summary
Name: _______________________________________ Date: _____________
Screening materials
Date sent to applicant:
Date item completed:
School/agency referral (if applicable)
Date item completed:
Written application
Date sent to applicant:
Date item completed:
Mentee interest survey
Date sent to applicant:
Date item completed:
Mentee interview
Date item completed:
Acceptance/rejection letter
Date item completed:
Eligibility Criteria:
Does the applicant meet each of the eligibility criteria? Please indicate with a yes or no beside each item.
_____ Legally blind
_____ Within age requirements of program
_____ Resides in (State)
_____ Willing to adhere to program policies and procedures
_____ Able to obtain parent/guardian permission (if appropriate) and ongoing
support for participation in the program
_____ Agrees to a two-year commitment
_____ Commits to monthly (eight hour minimum) face-to-face contact with
mentee
_____ Agrees to weekly contact with mentor by telephone or e-mail
_____ Agrees to attend required training sessions
_____ Willing to communicate regularly with State Coordinator and submit
required reports and activity information
Does the mentee applicant meet all eligibility criteria? Yes ______ No________
If no, are there any mitigating circumstances?
Overall comments:
Application Status
Date accepted: _____________Date acceptance letter sent: _______________
Matched: Yes: ___ Name of mentor: ______________________Date: _______
Date rejected: _______________Date rejection letter sent:: ______________
Reason: ________________________________________________________
_______________________________________________________________
Mentee Interview Form
Name: _______________________________ Date: ____________________
Home phone: ___________________ Cell phone: _____________________
Work phone: ____________________ E-mail: _________________________
Address: ____________________________ City: ______________________
County: _____________________State: _______________ ZIP Code: _____
Employer: _____________________ Job title: ________________________
Employment dates: _______to _________ Supervisor: __________________
High school/college/university: _____________________________________
NOTE: Before starting the interview, emphasize to the applicant the program expectations:
• You are making a two-year commitment to maintain this mentoring relationship;
• You agree to make monthly face-to-face contacts with your mentor;
• You agree to communicate weekly, either by phone or e-mail, with your mentor; and
• You agree to attend scheduled mentor/mentee workshops and activities.
NOTE: All answers given in this interview will remain confidential
Mentee Information:
Why are you interested in participating in a mentoring program?
What are you looking for in a mentor?
Tell me about your interests/hobbies.
What do you like most or find more satisfying about your interests or hobbies?
What types of activities do you do with your friends?
Describe a typical summer day for you.
Tell me about the most influential person in your life.
Have you ever met a blind person who has had a positive impact or influence on your life?
What role or responsibility do you feel you play in a mentoring relationship?
Describe a typical school or work day.
What types of activities do you like to do after school, work, or on the weekends?
Please list two or three of your most desired employment goals.
Please list and briefly describe two or three of your personal life goals. Examples of personal life goals may include goals for family, hobbies, education, and/or living location.
Are you involved in any social or community organizations? Examples of social or community organization may include church groups, bowling leagues, consumer organizations, sporting leagues, theatre groups, etc.
What do you expect or hope to gain from participation in this program?
What questions do you have about anything in your life that you believe a blind person can answer better than anyone can?
What is the one thing you want to learn or do more than anything?
Do you have any questions about the program and your responsibilities as a participant in the mentoring relationship?
Participating in this program requires a commitment of time and energy. Can you think of any reason why you might not be able to commit the necessary time and energy over the next two years?
What would you do if you knew you could not fail?
Mentee or Mentee/Parent Acceptance letter
**If the mentee is under the age of 18 the letter will need to be addressed to the parent or guardian, as appropriate. Otherwise it can be addressed to the mentee. Below is a sample letter addressed to the parent of a mentee:
January 29, 2007
Ms. Mary Belle
Street Address
City, State ZIP
Re: Noel Belle
Dear Ms. Belle,
We are excited to inform you of your daughter’s acceptance into the Bridges Mentoring Excellence Program. Our State Coordinator will contact you shortly after an appropriate match has been found for Noel. We appreciate your assistance in this process and look forward to communicating with you in the future.
We encourage your participation in Bridges activities; please feel free to contact the State Coordinator with any questions or concerns.
Sincerely,
Name
State Coordinator
Name of Mentoring Program
Contact Information
Mentee Rejection Letter
**If the mentee is under the age of 18 the letter will need to be addressed to the parent or guardian, as appropriate. Otherwise it can be addressed to the mentee. Below is a sample letter addressed to the parent of a mentee:
January 27, 2007
Celeste Waters
Street Address
City, State ZIP
Re: Jill Waters
Dear Ms. Waters,
On behalf of the [insert mentoring program name], I wanted to express my sincere thanks for your interest in our program. I understand that you have given a considerable amount of time to this process and we greatly appreciate your effort. Unfortunately, we are unable to accept your daughter’s application to be a mentee in our program.
I would be happy to discuss our decision with you. Please feel free to call me with any questions.
Thanks again and we wish you and your child much success.
Sincerely,
Name
State Coordinator
Name of Mentoring Program
Contact Information
3.5 Matching Procedure
Mentor Contract
Mentee Contract
Parent/Guardian Contract (if mentee is under the age of 18)
1. To begin the match process, the State Coordinator reviews the application, interview notes, and interest survey information of both the mentee and mentor to determine match suitability. Matching should be done only after each participant has completed the application process, is determined eligible for the program, and is ready, willing, and able to participate actively in the program. If you are unsure of someone’s commitment to the program, it may be better to exclude him or her from it. Also, if a good match to a mentor or mentee who is interested in participating is not available, then the person should be put on a waiting list, rather than matched sub-optimally.
The following criteria should be used in determining the match. Preference should be given to the criteria in the order they are presented. In other words, use gender as the first criteria, followed by cultural and age similarity.
• Gender
• Similar culture
• Closer in age the better (three to six years difference is optimal)
• Similar personalities
• Geographical proximity
• Similar career interests
• Level and/or cause of blindness
Ultimately, the match decision is at the discretion of the State Coordinator. These criteria provide a structure and guide, but are not meant to supersede extenuating factors. There is no clear-cut answer when matching mentors and mentees. If the mentor and mentee commit to spending time together and getting to know each other, common interest will develop and the relationship will solidify.
2. Once a potential match is identified and before contacting any of the prospective participants, the State Coordinator must review the files of the potential mentor and mentee to ensure all screening procedures have been completed and both have met all the eligibility criteria.
3. The State Coordinator should then first contact the prospective mentor and without using the young person’s name, describe and provide information about the mentee.
4. Given initial interest by the mentor, the State Coordinator then provides the mentee, if over the age of 18, with a description and information about the prospective mentor. If the mentee is under the age of 18, the State Coordinator provides the above mentoring information to the mentee’s parent/guardian. If the mentor and the parent/guardian, (as appropriate) of mentee agree, the coordinator will then contact the mentee and describe the prospective mentor to him or her. The mentee is informed last so as to minimize disappointment if either the mentor and/or parent/guardian does not approve of the suggested match in some way.
5. The official announcement of mentors and mentees occurs at the kickoff. The kickoff should occur within two weeks of the mentor/mentee match discussion. During the kickoff introductions are facilitated by the State Coordinator through relationship building activities.
6. If all agree to move forward with the match, the mentor, mentee, and parent/guardian (if appropriate) read and sign contracts. Copies of all are given to each party and placed in the respective mentor and mentee file.
7. The first mentor and mentee match meeting date and time should be confirmed. Telephone numbers and addresses can be exchanged at this time.
8. If the young person is under the age of 18 it is recommended that a copy of the mentee's health insurance card or health insurance provider information be provided to the mentor.
9. Once the match is made, program staff will add the mentor/mentee name to the log sheet of the mentee/mentor files and schedule the first follow-up call to each person within the first week following their first meeting date.
Note: Place copy of both contracts in both mentor and mentee files.
[insert name] Mentoring Program
Mentor Contract
Note: place copy in both mentor and mentee files.
Name: __________________________________Date: __________
By choosing to participate in the [name of mentoring program], I agree to:
• Follow all rules and guidelines as outlined by the State Coordinator, mentor training, program policies, and this contract.
• Promote a positive attitude of blindness.
• Be flexible and provide the necessary support and advice to help my mentee succeed.
• Reinforce the “Five Essential Elements for Success.”
• Encourage the use of alternative techniques and obtaining proper training.
• Make a two-year commitment to being matched with my mentee.
• Meet at least eight hours per month with my mentee.
• Make at least weekly contact with my mentee by telephone or e-mail.
• Obtain parent/guardian (if appropriate) permission for all meeting times at least three days in advance, if possible.
• Be on time for scheduled meetings or call my mentee at least 24 hours beforehand if I am unable to make a meeting.
• Submit required reports to the State Coordinator.
• Communicate monthly with the State Coordinator about the status of the mentoring relationship.
• Inform the State Coordinator of any difficulties or areas of concern that may arise in the relationship.
• Keep any information that my mentee tells me confidential except that which may cause him/her or others harm.
• Ensure that my driver always obeys traffic laws when in the presence of my mentee, and keep a copy of mentee’s health insurance coverage (if under the age of 18) in the automobile at all times when traveling together.
• If my mentee is under the age of 21, never be in his/her presence when I have been or am consuming alcohol or controlled substances. If my mentee is 21 and older, I will not abuse alcohol and will keep my level of consumption to a two drink maximum.
• Participate in a closure process when that time comes.
• Notify the State Coordinator if I have any changes in address, phone number, e-mail, or employment status.
• Attend in-service mentor training sessions twice per year.
• Participate in mentor teleconferences.
_______ (please initial) I understand that upon match closure, future contact with my mentee is beyond the scope of the [insert mentoring program name] Mentoring Program and may happen only by the mutual consensus of the mentor, the mentee, and the parent/guardian (if appropriate).
I agree to follow all the above stipulations of this program as well as any other conditions as instructed by the State Coordinator at this time or in the future.
_______________________________________ ____________
Signature Date
[Insert name of mentoring program]
Mentee Contract
Note: Place copy in both mentor and mentee files.
Name: __________________________________Date: __________
Mentee Responsibilities:
A person takes on a lot of responsibility when he or she agrees to be a mentor. As a mentee in this program you will have responsibilities as well. As a mentee you are asked to read the agreement below and sign it as an indication of your commitment to the program. If you have any questions, please contact your State Coordinator.
As a mentee in the [Insert name of mentoring program], I agree to:
• Follow all rules and guidelines as outlined by the State Coordinator, mentee training, program policies, and this contract.
• Make a two-year commitment to be matched with my mentor.
• Meet at least eight hours per month with my mentor.
• Make at least weekly contact with my mentor by telephone or e-mail
• Be on time for all arranged meetings or call my mentor at least 24 hours beforehand if I am unable to make a meeting.
• Participate in program activities, including meetings and teleconferences.
• Try new and beneficial activities with my mentor.
• Communicate with my mentor about any changes in meeting arrangements.
• Notify my mentor or the State Coordinator, if I am unable to continue in the mentoring program.
• Notify my mentor or the State Coordinator, if I have any changes in address or phone number.
• Inform and discuss with my parents/guardians activities to be undertaken with my mentor, if I am under the age of 18.
• Inform the State Coordinator immediately if a problem arises.
• Be respectful of my mentor and others associated with the program.
• Submit to the State Coordinator any reports as requested.
_______ (please initial) I understand that there are limits to the confidentiality of my relationship with my mentor and I agree to these limits. If I disclose information of immediate concern, such as physical or sexual abuse, self-harm, or violence toward another person, the mentor is obligated and has agreed to report this information to the program. This policy exists for my welfare and the welfare of those affected by the situation.
_______ (please initial) I understand that upon match closure, future contact with my mentor is beyond the scope of the [program name] and can happen only by the mutual consensus of the mentor, the mentee, and the parent/guardian (if appropriate).
_______________________________________ ____________
Signature Date
[Insert name of mentoring program]
Parent/Guardian Contract
(if mentee is under the age of 18)
Note: Place copy in both mentor and mentee files.
Name: _______________________________________Date: ______________
By allowing my son/daughter to participate in the [mentoring program], I agree to:
• Encourage my child to follow all rules and guidelines as outlined by the State Coordinator, mentee training, program policies, and this contract.
• Encourage my child to use and develop the blindness skills he/she learns in the mentoring process.
• Support my child in this match by allowing him/her to meet with his/her mentor at least eight hours per month and have weekly contact with him/her for two years.
• Support my child being on time for scheduled meetings or have him/her call the mentor at least 24 hours beforehand if unable to make a meeting.
• Regularly and openly communicate with the State Coordinator as requested.
• Inform the State Coordinator, [insert name], if I observe any difficulties or have areas of concern that may arise in the match relationship.
• Notify the State Coordinator, if I have any changes in address or phone number.
• Provide the State Coordinator and the mentor with any updated health insurance information for my child.
_______ (please initial) I understand that upon match closure, future contact between my child and his/her mentor is beyond the scope of the [program name], and can happen only by the mutual consensus of the mentor, the mentee, and the parent/guardian (if appropriate).
I agree to follow all the above stipulations of this program as well as any other conditions as instructed by the State Coordinator at this time or in the future.
______________________________ _____________________________
Mentee name Parent/guardian name
_____________________________________ _______________
Parent/guardian signature Date
3.6 Training Procedure
3.6.1 General Training Procedures
Each mentor and mentee must attend a training session before being matched, in addition to attending at least two trainings/activities per year of involvement in the mentoring program.
1. The State Coordinator has the lead role in managing session logistics, developing curricula and training materials, facilitating the session, and processing the training evaluation forms. Sessions should be conducted by program staff using suggested materials provided by the National Center for Mentoring Excellence, experts in the field of mentoring, and mentors and mentees currently in the program.
2. A training and activity evaluation form should be completed by each participant at the completion of each scheduled training and activity. Evaluating the training offers feedback on the success of the training according to mentors and mentees. Coordinators can then use this to plan future events.
3. One week before the training, the coordinator should contact the participants to remind them about the training.
4. Basic mentor and mentee training sessions should be held before the onset of the mentoring relationship. Training should occur over a two day period. Typically, this works well when done over a weekend, with a welcoming dinner on Friday evening, concluding with mentor/mentees making plans for the next stage of the relationship on Saturday evening or Sunday morning.
3.6.2 Initial Training Session
1. After potential mentors and mentees have completed the screening process and have been accepted to participate in the program, the coordinator should notify participants of the date and time of the training. It is also recommended that more mentors than needed participate in all the trainings, so that in those instances when mentors drop out, there is already a pool of mentors trained and ready to go.
2. The State Coordinator should also assist with the facilitation of transportation, when needed. Mentors may also be able to assist with facilitating transportation.
3. Content for the initial training sessions must include:
a. Basic program guidelines;
b. Safety issues;
c. Communication/relationship building skills;
d. Confidentiality;
e. Plans for the next two years; and
f. Sexual abuse prevention, which is mandatory for all mentors and mentees.
3. Mentoring Training/Activities
Training and Activity Evaluation Form
Training/activities should be structured in a manner that will strengthen the mentoring relationship. The training/activities provide a means for the young person to spend additional one-to-one time with the mentor, while affording an opportunity for the young person to have contact with blind peers and additional blind role models from all walks of life.
1. Once matched, each mentor and mentee should attend at least two scheduled mentoring training/activities annually, in addition to the initial mentor/mentee training and the kick-off.
2. Content for the training/activities will be determined based on feedback provided by mentors and mentees during the support teleconferences. Topics should always include a theme related to the Five Essential Elements for Success (Section 3.6.4) while incorporating themes such as communication strategies, goal setting, and career exploration.
3. It is recommended that an attendance of mentors and mentees be logged and tracked for the purpose of reporting training and activity hours to funders.
4. All participants (mentors, mentees, parents/guardians, and program staff) in mentoring training and activities should be given the opportunity to provide written evaluations of the trainings’ and/or activities’ effectiveness related to the mentoring relationship. The training and activity evaluation forms should be provided in alternative formats and readers/scribes (who are not presenters) should be provided so that participants are able to give feedback anonymously. Another way to encourage participation in the evaluation process is to have the evaluations available online.
Training and Activity Evaluation Form
Date of training or activity:
Directions:
Please respond to the items below and on the second page of this form. This information will be helpful in future planning. Please rank the indicated items on the scale from one to five (one is low, five is high). Circle or scratch (erase) your response for each item. Please write legibly, as your comments are very important.
I am a:
__Mentor __Mentee/youth __Parent/guardian __Program Staff __Other
Overall Workshop Feedback
1. Your overall satisfaction with the workshop
Low 1 2 3 4 5 High
2. Importance of the content covered in the workshop
Low 1 2 3 4 5 High
3. Quality of the speakers and presentations
Low 1 2 3 4 5 High
4. What suggestions do you have for improving the overall quality of the next workshop?
Extracurricular Activity
5. How was the quality of group interaction and participation during the activity?
Low 1 2 3 4 5 High
6. How effective or relevant was the extracurricular activity in supporting the overall goals of the mentoring program?
Low 1 2 3 4 5 High
7. How effective or useful was the extracurricular activity in increasing the one on one time between mentor/mentee?
Low 1 2 3 4 5 High
Additional Comments
Please write or Braille your responses to the following questions. Your opinion is very important to us.
A. What did you like most about this workshop?
B. What did you like least about this workshop?
C. What would you like to have more, or less, of at the next workshop?
3.6.4 Five Essential Elements for Success
The following is from the National Center for Mentoring Excellence Mentor Handbook:
As a mentor, every contact you make with your mentee will require that you keep the Five Essential Elements for Success in the forefront of your mind and relationship. Building the mentoring relationship is important, but our ultimate goal is to develop young adults with a healthy attitude about their blindness and skills.
Mentors are provided and encouraged to read Freedom for the Blind, which provides more information about these Elements. You will note the Five Essential Elements are not listed as such in Freedom; this is a term the National Center for Mentoring Excellence has chosen to trigger thoughts about what we believe about blindness and what it takes to be successful as a blind person.
Following each of the Elements are suggested readings that will support the Elements. Through these readings, you will find examples of topics to discuss with your mentee, possible responses to use when a particular situation occurs, and ideas for activities to do with your mentee.
1. It is OK to be blind (Freedom for the Blind, Chapter 8)
The blind youth/young adult must come emotionally, not just intellectually, to know that he or she can truly be independent and self-sufficient.
• Acceptance of blindness
• Why we use the word “blind”
• It is respectable to be blind
• Blind people are normal, ordinary people who can’t see
• The blind are a cross section of society
• Blindness is a characteristic
• Blindness is not a tragedy
• The more vision a person has does not equate to the level of success(hierarchy of sight)
• Importance of blind role models
The Day after Civil Rights, The Master, the Mission, the Movement
The Pitfalls of Political Correctness, The Master, the Mission, the Movement
I Want That, The Freedom Bell
Remember, Making Hay
Future Reflections Special Issue: Low Vision and Blindness, 2005
Riding on One Wheel, Celebrate
Tapping the Charcoal, Tapping the Charcoal
An Unplanned Walk in the Blizzard, Not Much of a Muchness
Wall-to-Wall Thanksgiving, Wall-to-Wall Thanksgiving
Blindness: Handicap or Characteristic, The Master, the Mission, the Movement
Wall-to-Wall Thanksgiving, Meeting the Challenge
My Long Journey from Partially Sighted to Really Blind, Future Reflections, Fall, 2003
Language and the future of the blind, Marc Maurer, Denver, Colorado, July 8, 1989
Cutting the Cake or Copping Out, Freedom
2. Blindness skills (Freedom for the Blind, Chapter 9)
The blind youth/young adult must really master and become competent in these skills, the alternative techniques of blindness, which will make it possible for him or her to be independent and self-sufficient.
• With proper training and opportunity, blindness can be reduced to the level of a mere inconvenience and nuisance
• Independent travel--starts with a white cane
• Braille=literacy
• Computers and technology equals access
• Life as an independent blind person
• If you can dream it--you can do it
• Dealing with the “How’s”—"How will I get to work?” “How do I find the concession stand?” “How will I maneuver through a cafeteria line at school?” “How will I go on a date?” “How, How, How?”
• Raised expectations
Hamburgers and the Practice of Law, The Freedom Bell
Blind Faith, What Color is the Sun
As Mean as My Mom, What Color is the Sun
Flashing Rake and Blaring Radio, Celebrate
The Blessings of Braille, The Lessons of the Earth
The Scenic Lighthouse Walk, Braille Monitor, July, 2006
3. Coping with public attitudes (Freedom for the Blind, Chapter 10)
The blind youth/young adult must learn to cope on a daily basis with public attitudes about blindness.
• The real problem of blindness is not the loss of eyesight, but public misconceptions and misunderstanding
• The blind are a part of the public and also have misconceptions and misunderstandings about blindness
• How to create a positive attitude about blindness
• How to act in a courteous manner when you don’t feel very courteous
Swabbing the Deck, Celebrate
Don’t Throw the Nickel, The Master, the Mission, the Movement
You Will Have to Make Other Arrangements, Like Cats and Dogs
Crying Over Spilled Milk, Freedom
4. Blending in (Freedom for the Blind, Chapter 11)
The blind youth/young adult must also learn to “blend in” and to be acceptable to others. He or she must be punctual, reliable, neat and appropriate in appearance, and the like.
• Complete integration into the broader society and employment –successful, high quality employment
• With equal rights comes equal responsibility – learn to pull your own weight
• Blending in does not mean avoidance of the blind
• Reliability
• Blindisms
• APPEARANCE—APPROPRIATE TO THE OCCASION—IS IMPORTANT!
• Etiquette
• Table manners
• Social skills
• The blind are judged by one another
On Emptying Wastebaskets, The Freedom Bell
Gray Pancakes and the Gentleman’s Hat, Grey Pancakes and Gold Horses
Carol’s Compliment, To Reach for the Stars
Competing on Terms of Equality, The Master, the Mission, the Movement
You’re Not in Kansas Anymore, Dorothy, Future Reflections, Fall, 2006
5. Giving back (Freedom for the Blind, Chapter 8, pages 88-89)
The blind youth/young adult must learn the value of giving back, by becoming an active and contributing member of the organized blind movement as well as his or her local community.
• Prepare to help future generations
• Benefits of giving back
• Automatic support system
• Prevents “back-sliding”
When the Blizzard Blows, When the Blizzard Blows
Lisamaria: Focusing on Others, Making Hay
Reflections on Mentoring, Braille Monitor, July, 2006
Making a Difference, Braille Monitor, July 2008
Serving, Oh Wow!
As noted above, our goal is to see significant progress in mastery of the Five Essential Elements for Success. We want not only to see progress in saying the right words, but having the mentee’s actions and beliefs actually mirror a positive attitude. This is where the role of the blind mentor is essential and fundamental.
It is important that selected mentors for this program strive, at all times, to display a healthy perspective on living as a blind person. Naturally, perspectives and experiences that you have acquired and encountered as blind people may have colored and biased your opinions on various matters. This is all too human and understandable. It is important, though, to offer a positive and philosophically sound set of ideas to impressionable mentees. Please make every effort, then, to be mindful of this standard, particularly where any individual experiences you have had may have resulted in an alteration in views which may be at odds with the basic messages that we want to convey. The skills of judgment that you will no doubt help foster with your mentee will be more than sufficient to allow him or her to make personal decisions about what he or she thinks and feels with respect to any thorny topic. When discussing matters rife with potential controversy, please facilitate a thorough examination of all perspectives, with the aim of ultimately making clear a constructive approach or resolution to any such question.
The contributions that you, as a blind mentor, will make in the lives of aspiring blind people, early in their emotional maturing process, are immeasurable. As you offer this support, reflect on the benefits that you may have received from previous generations of blind people, even if informally, and you will begin to appreciate the value of your commitment. You have the potential to profoundly alter the life of a blind person for the better. This is your daunting task. Your selection as a mentor means that there is little doubt that you are equal to this challenge.
3.7 Match Support and Supervision Procedure
3.7.1 Supervision
1. Once matched, the Program Coordinator will support and monitor the match
including the mentor, mentee, and parent/guardian (if appropriate).
2. Within one week of the first activity date of a new match, the Coordinator should make phone/personal contact with all parties to determine how the first meeting went. Inquiries should be made about the kind of contact, length of time spent together, and topics discussed. At that time, the State Coordinator should make the first entries in the respective mentor or mentee contact sheet.
3. If there appears to be a connection between the mentoring pair, the State Coordinator should then follow up monthly by phone with each party to gather information regarding meeting dates, times, activities, and how the match is proceeding. Three attempts to contact each party should be made in a given month before a written letter or note is mailed requesting they call the State Coordinator. If there is not a connection, the Coordinator should continue to contact the mentoring pair by phone/personal contact, continuing to encourage and offer support to all on a weekly basis. With each contact, information should be recorded in the respective mentor or mentee contact sheet.
4. In order to assess how the match is proceeding, the State Coordinator may inquire about the following and/or probe beyond to uncover core issues:
• Are they enjoying participating in the match?
• How do they feel it is going?
• Are they having any difficulties?
• Is the relationship developing as they would like?
• If not, why do they think it is not working?
• Are there any concerns or issues that should be addressed by program staff?
• Do they need more support or any intervention?
5. In accordance with the training policy and procedures, the State Coordinator should periodically remind the mentor, mentee, and parent/guardian (if appropriate) of the scheduled trainings/activities requirement for mentors and mentees.
3.7.2 Problem Resolution
1. If the coordinator assesses that there is a potential problem with the match, the coordinator should attempt to clarify the potential problem and work with the mentor, mentee, and/or parent/guardian to resolve the issue early.
2. The ideal model for the general process for resolving problems includes:
• Identify the problem and have a clear-shared understanding of the problem between the mentor, mentee, and/or parent/guardian.
• Develop alternative solutions that could address the problem.
• Evaluate the strengths and weaknesses of each solution.
• Act on the most constructive solution.
• Learn from how the solution worked and repeat the IDEAL process if necessary.
3. When the match problem involves a lack of contact on the part of the mentor or mentee, the Program Coordinator must investigate the reasons for lack of contact with the offending party and make efforts to ensure the individuals are meeting according to the contracted amount of time per month.
4. If a problem area continues, the coordinator should consult with the affiliate president and other program advisors to define a viable approach to address the problem and propose potential solutions.
5. If the problem cannot be resolved, formally closing the match may be necessary. At that time, it would be determined if either or both parties are suitable for re-matching with other partners.
6. All support and supervision by program staff should be recorded on the respective Mentor/Mentee Contact Sheets, referencing any notes included in the files.
Other Support
It is the responsibility of the State Coordinator to provide other support to the matches, including but not limited to the following:
• Identify mentoring activities and assist in planning and implementing group activities for mentor/mentee matches.
• Facilitate an ongoing support group for mentors through monthly mentor teleconferences and quarterly mentee teleconferences.
• Active participation in mentoring listserv. State Coordinators can pose questions and post relevant information that will support the mentoring relationship and offer ideas and suggestions of activities for the mentoring pairs.
3.8 Recognition Procedure
Below are suggested recognition activities for mentors in your program. The recognition procedure, however, does not limit recognition as a daily part of “business” or other activities that may be undertaken throughout the year.
1. Host a participant recognition event such as a picnic, dinner, or other activity. At this event, present a mentor and mentee of the year award. A committee developed by the Program Coordinator can determine award criteria and make final determinations based on recommendations from the Coordinator. Other suggested acknowledgments may include length of service (mentors), recruitment of other mentors, most improved attitude regarding blindness (mentee), or other outstanding achievements. Recognition may include a certificate or a nominal gift determined by the committee and budget allowance.
2. Cards from program and agency staff may be sent to mentors during each December/New Year holiday season and for the mentor’s birthday.
3. Recognition for length of volunteer service includes:
• At one year, a letter of appreciation may be sent to the mentor’s place of employment, recognizing the mentor’s commitment to the program.
• After two years of service, all mentors may be sent a certificate of appreciation and a handwritten thank-you note or card.
• At five years of service, engraved plaques may be presented for continuous service.
4. All awards and recognitions should be written up in a press release that will be distributed to local media.
Outstanding mentors may be asked to assist in presenting at new mentor orientation and training sessions by invitation of the State Coordinator.
9. Mandatory Reporting of Abuse and Neglect Procedure
Abuse and Neglect Report
All staff, agency representatives, and mentors/mentees must adhere to the mandatory reporting procedures of the representing agency/ organization. For those programs that do not have written policy and procedure for reporting abuse and neglect, the following procedure will be considered approved procedure:
Suspected Abuse or Neglect
1. All suspected incidents of abuse or neglect, recent or otherwise, must be reported to the State Coordinator immediately, the same day if possible.
2. The State Coordinator must fill out the Abuse and Neglect Report form detailing critical information about the alleged incident of abuse or neglect. Once completed and reported, this form will be kept in the mentee’s file folder.
3. The State Coordinator must then file a report with the respective Department of Children and Family Services (DCFS) within 24 hours per state statute for young adults under the age of 18 and to the local police authority for those participating over the age of 18. Check with the local DCFS to determine if age 18 is the end age for reports to the DCFS. The procedure for reporting will be adjusted according to state statute.
4. If knowledge of the suspected abuse or neglect occurs during non-business hours, the mentor must:
• contact the State Coordinator or
• make the report to the local community abuse hotline or directly to DCFS or to the local police department.
The mentor must first attempt to contact agency/program staff. If unable to do so at the time, he/she must file a report with the State Coordinator by noon the next business day. The State Coordinator must follow steps 1 and 2 above and follow up with the proper authorities to ensure the report was adequately made by the mentor.
In some cases, the responding authority may require the mentor to be interviewed or make contact with them directly. In such cases, the State Coordinator will accompany the mentor as allowed by requesting authority.
Suspected Abuse or Neglect by Program Staff or Volunteers
1. The same procedures outlined above will be followed for any suspected abuse and neglect by any staff person, program representative, or volunteer.
2. In addition, the alleged abuser will be investigated by local mentoring program executive staff and advisors.
3. During such an investigation, the alleged abuser will be immediately restricted from contact with young adults, placed on probation, terminated, or suspended from participation in the program.
4. In the case of suspicion of a mentor, the parent/guardian (if appropriate) will be immediately informed of the suspicion.
Training
1. All program staff, agency representatives, and volunteers must be trained on state statutes of abuse and neglect laws and the agency’s mandatory reporting policy and procedures prior to working with youth or participating in the mentoring program.
2. Reporting of abuse and neglect is mandated by the policy and procedure training and is included as a required topic in the training curriculum outline for both mentors and mentees.
Abuse and Neglect Report
Date: ___________
Person making report: _____________________________________________
Relationship to youth: ______________________________________________
Reported to: __________________________________ Date: ______________
(DCFS/Police Department staff name)
Title: __________________________________________
(of DCFS/Police Department worker to whom reported)
----------------------------------------------------------------------------------------------------------
Name of youth: ___________________________________________________
Age: ___ Date of birth: ________ Address: _____________________________
City: ______________________________ State: _________ ZIP: __________
Telephone: ______________________________________________________
Parent/Guardian (if appropriate):_____________________________________
Relationship to youth: ______________________________________________
----------------------------------------------------------------------------------------------------------
Name of person suspected of abuse or neglect: _________________________
Relationship to the youth: ___________________________________________
Describe the suspected abuse or neglect. Include the nature and extent of the current injury, neglect, or sexual abuse to the young person in question.
Describe, if known, the circumstances leading to the suspicion that the young person is a victim of abuse or neglect.
Describe, if known, any previous injuries, sexual abuse, or neglect experienced by this youth or other children in this family situation and any previous action taken, if any.
10. Closure Procedure
Match Closure Summary
Mentor Exit Survey
Mentee Exit Survey
Parent/Guardian Exit Survey
Closure Letter
Program staff should follow the closure procedures as closely as possible. The closure procedure will vary based on the reasons for the match ending:
1. At the point it is decided that a match is closing, the Program Coordinator will fill out a Match Closure Summary form, then supervise and instruct all participants through the closure process. A copy of the Match Closure Summary will be placed in both the mentor and mentee files.
2. All closures must be classified as to the reason for the match ending. The major classifications are as follows and the circumstances will dictate the procedure to be followed:
• Planned:
A planned closure is one that has been known about for a period of time such as three months or more. A common reason for planning a match closure may include the match reaching the end of the two-year commitment.
• Extenuating:
Extenuating circumstances for match closure are usually more sudden in nature and beyond the control of the program and/or its participants; i.e., relocation or moving away, or an unexpected personal crisis.
• Difficult:
A difficult match closure is due to relationship or behavioral difficulties, i.e., lack of cooperation or contact, parental disapproval, irreconcilable issues, lack of compatibility, and/or violations of program policies.
3. In all cases, attempts will be made to have a closure meeting to include the State Coordinator, the mentor, and mentee. The parent/guardian (if appropriate) may attend if he/she desires. The meeting agenda should cover the following, depending on the circumstances of closure:
• Discuss the relationship ending
• Complete the closure Exit Surveys—if applicable.
• Discuss the program’s policy regarding future contact
• Distribute participant Closure Letters
4. In the absence of a meeting, program staff will attempt to contact all parties by phone to inform them that the match is closing and to ask how best to proceed in closing the match. Closure Letters and Exit Surveys will be mailed out to the mentor, the mentee, and parent/guardian (if appropriate), and will include enclosed, self-addressed, stamped envelopes.
5. In all circumstances, the mentor, mentee, and parent/guardian (if appropriate) should all receive a Closure Letter stipulating that the match has formally ended and that any future contact is beyond the scope and responsibility of the mentoring program.
6. Copies of the Closure Letters and all completed Exit Surveys should be placed in the respective mentor or mentee files.
7. Depending on planned future participation in the program, the files of mentors and/or mentees exiting the program should be kept active or placed in the program archives.
Match Closure Summary
Name of mentee: _________________________________________________
Name of mentor: _________________________________________________
Match date: ____________ Closure date: _________
Length of match: _________
Please check the circumstance and check the reason for match closure:
PLANNED
Mentor:
___ Completed two-year match
___Other, specify:
Mentee:
___ Completed two-year match
___Other, specify:
EXTENUATING
Mentor:
___ Relocation
___ Life
___ Time/schedule conflict
___ Family/personal\health
___ Other, specify:
Mentee:
___ Relocation
___ Life
___ Time/schedule conflict
___ Family/personal\health
___ Other, specify:
DIFFICULT
Mentor:
___ Violation of policy
___ Behavioral problems
___ Lack of cooperation with mentoring program
___ Parent/guardian withdrew youth
___ Lost interest
___ Other, specify:
Mentee:
___ Violation of policy
___ Behavioral problems
___ Lack of cooperation with mentoring program
___ Parent/guardian withdrew youth
___ Lost interest
___ Other, specify:
Additional details concerning the closure:
Recommend rematch?
Mentor: ___ Yes ___ No Mentee: ___ Yes ___ No
Completed by: ____________________________Date: __________
Note: Place copy in both mentor and mentee files
[mentoring program name]
Mentor Exit Survey
Thank you for serving as a mentor in the [insert name of mentoring program]. Your efforts are greatly appreciated. We are always looking for ways to improve our program and appreciate your feedback. Your responses are confidential and important to us.
Please complete the following and return to the [mentoring program].
Name: _________________________________________ Date:____________
Name of Mentee: _________________________________________________
Length of Match: ___years ____months
Check what best describes your relationship with your mentee:
___Very close ___Close ___Not very close
Check what best describes the success of your mentoring relationship:
___Very successful ___Successful ___Not very successful
Do you feel as if you made a difference in your mentee’s life?
___Yes ___No
Did you feel you received adequate support and supervision from program staff?
___Yes ___No
Please explain your answers below:
Why is your match ending?
What aspects of the mentoring program did you like the best?
What aspects of the mentoring program did you like the least?
What could we have done to make our program a better experience for you and/or your mentee?
Would you like to be re-matched? ___Yes ___No
Please provide any additional comments:
Please return completed form to: [insert state coordinator contact information]
[mentoring program name]
Mentee Exit Survey
Thank you for being a mentee in the [insert name of mentoring program]. We hope that you found your experience in the program fun as well as beneficial.
Please help us to continue to provide a quality program by completing this brief survey. Your responses are confidential and important to us. Please complete the following and return to the [mentoring program].
Name:_____________________________________________ Date:________
Name of Mentor: _________________________________________________
Length of Match: ___years ____months
Check what best describes your relationship with your mentor:
___Very close ___Close ___Not very close
Check what best describes the success of your mentoring relationship:
___Very successful ___Successful ___Not very successful
Do you feel as if your mentor made a difference in your life?
___Yes ___No
Did you feel you received adequate support and supervision from program staff?
___Yes ___No
Please explain your answers below:
Why is your match ending?
What aspects of the mentoring program did you like the best?
What aspects of the mentoring program did you like the least?
What could we have done to make our program a better experience for you and/or your mentor?
Would you like to be re-matched? ___Yes ___No
Please provide any additional comments:
Please return completed form to: [insert state coordinator contact information]
[mentoring program name]
Parent/Guardian Exit Survey
Thank you for allowing your child to participate in the [insert name of mentoring program]. We hope that you found your child’s experience in the program fun as well as beneficial.
Please help us to continue to provide a quality program by completing this brief survey. Your responses are confidential and important to us. Complete the following and return to the [mentoring program].
Your Name: ___________________________________ Date: _____________
Child’s Name: ____________________________________________________
Relationship to Child:______________________________________________
Name of Mentor: _________________________________________________
Length of Match: ____years ____months
Check what best describes your child’s relationship with his/her mentor:
___Very close ___Close ___Not very close
Check what best describes the success of your child’s mentoring relationship:
___Very successful ___Successful ___Not very successful
Do you feel as if your mentor made a difference in your child’s life?
___Yes ___No
Did you feel you and your child received adequate support and supervision from program staff?
___Yes ___No
Please explain your answers below:
Why is the match ending?
What aspects of your child’s mentoring program did you like the best?
What aspects of your child’s mentoring program did you like the least?
What could we have done to make our program a better experience for your child, and his/her mentor?
Would you like your child to be re-matched? ___Yes ___No
Please provide any additional comments:
Please return completed form to: [insert state coordinator contact information]
Sample Closure Letter
(Name of Mentor, Mentee, or Parent/Guardian)
123 Jolly Street
Happy City, Delaware 45678
Dear (first name):
This letter is to inform you that the mentoring relationship through the [insert mentoring program name] has officially ended as of (month day, year). We hope that your mentoring experience has been fun and rewarding.
(Optional if applicable) We have made attempts to contact you via phone and e-mail to no avail and regret that we are unable to meet with you and go through a formal closure process.
As the match has formally ended, the [insert mentoring program name] no longer assumes responsibility for monitoring and supervising the match and your file will be placed on an inactive status. Thus, any future contact between match partners is at the sole discretion of all parties involved (mentor, mentee, and parent/guardian, if appropriate). Any incidents occurring due to future contact among match participants is beyond the scope and responsibility of the [mentoring program].
Thank you for your involvement in our program. We appreciated your participation. Please feel free to contact me if you have any questions.
Sincerely,
Gina Meanwell, Coordinator
XYZ Mentoring Program
SECTION 4: Evaluation Procedure
Evaluations of the mentoring program should follow a systematic plan for evaluation that includes output, intermediate outcome, and end outcome measures, defined as:
Outputs are measures of productivity and process (e.g., number of services, amount of time spent).
Intermediate Outcomes are the milestones and objectives of the program that are expected to lead to successful attainment of the goals (e.g., self-esteem, computer skills).
End Outcomes are the ultimate program and individual goals that the project is attempting to achieve. These have been identified as academic success, competitive employment, and community integration.
In the development of an evaluation plan, coordinators should consider all activities from planning through program completion in order to conduct a comprehensive evaluation. Program brochures, applications, announcements, presentations, phone calls, and personal contacts are as important to the successful evaluation of the program as are job placements for youth. Each evaluation plan should be sure to capture both quantitative and qualitative data. Quantitative measures may include factors such as the number of applications mailed, number of enrollees, and number completing the program, to more complex measures such as statistical measures of group-level changes in goal attainment in comparison to non-participating youth. Qualitative data are typically case studies and anecdotal testimony given in verbal or written form by program participants that attest to their overall satisfaction, concerns, and/or lessons learned. Evaluation plans may be customized to meet the unique needs of states and organizations. However, every plan must capture at least one output, an intermediate outcome, and an end outcome.
Development of an evaluation plan should follow a logical progression from the need to actions through to the anticipated results. The following table gives an example of how a plan may begin and/or specific items that a plan may include.
Logic Model for Evaluation
Need: Blind youth lack support for transition-to-work
Objective: Match blind youth with successful mentors
Actions: Program provides structure and opportunity while mentors guide youth through VR/college systems
Outputs: Match blind youth with blind adult role models, mentor and mentee face-to-face contact, weekly phone calls, e-mail
Intermediate Outcomes: Increased self-esteem, increased knowledge/access to VR services
End Outcome: Academic success, greater participation in community, and employment at a higher rate of pay
Measures/Output: number of applicants enrolled, number of successful matches, and number of duration contacts
Measures for Intermediate Outcomes: Increased scores on esteem measure and number of self-initiated contacts with VR counselor
Measure of End Outcome: Changes in GPA, scores on community integration scale, and reports from family and friends
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