Fillable CAST Mentoring Program Spring/Summer 2018 Professional Boundaries Statement (Fairmont State College)

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CAST Mentoring Program Spring/Summer 2018 Professional Boundaries Statement (Fairmont State College)

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1 | Page
CAST Mentoring Program –Spring/Summer 2018
Professional Boundaries Statement
*Must be completed as part of application process
Ashley M. Knight | Alumni Relations and Annual Giving Coordinator | 304.367.4015
Engagement in the Falcon Mentorship Program affords the mentor/mentee is a part of the broader campus
community, and as such, participants must respect the codes of social justice and harassment set forth by the
university.
- Board of Governors Social Justice Policy #8
Consistent with its comprehensive mission, and recognizing that the development of human potential is a
fundamental goal in a democratic society, the Fairmont State Board of Governors promotes an educational
system that values cultural and ethnic diversity and understanding; that provides for the preparation of students
for full and meaningful participation in a changing world; and that promotes equitable and fair treatment in
every aspect of campus life and employment for all persons, regardless of race, color, national origin, sex, sexual
preference, sexual orientation, age, religion, veteran status, or disability.
- Policy on Sexual Misconduct and Sexual Assault
Fairmont State will not tolerate, in any manner, any sexual assault, sexual harassment, domestic or dating
violence, stalking, hostile environments or other forms of gender or sex discrimination on campus or at any
campus-related facility, or in any institution-sponsored activity, program, trip or process and complies fully with
all aspects of Title IX, including the Violence against Women Act (VaWA) and Campus Sexual Violence
Elimination Act (Campus SaVE) of VaWA. Violators will be prosecuted to the fullest extent of campus processes
and/or the law. (2016-2017 Student Handbook)
Please fill out the following:
Through understanding of the above policies, I, ________________________________________
agree to uphold the values of social justice and the integrity of professional boundaries inherent to a mentoring
relationship.
As part of the Falcon Mentorship Program I, _______________________also agree to the following:
• to conduct myself in a respectful manner,
• to engage in a strictly professional relationship with my mentee/mentor,
• and to respect the time and privacy of my mentee/mentor.
2 | Page
Mentor Personal Statement
As part of the application process, a personal statement is required that will address your goals and objectives as well as
clarifies your career path and interests. We will use this information to better inform the matching of alumni and student.
First Name
Last Name
Preferred Address
Preferred Phone
Number
Preferred Email Address
Preferred Method of
Contact
Email Phone No Preference
Graduation Date(s)
Degrees Obtained from
Fairmont State
Career(s)
List of Skills (ex.
Microsoft, design,
certifications, etc.)
How do you prefer to
meet your mentee(s)
In Person
Video/Phone Conference
Calls
No Preference
Please state the number
of mentees you are
willing to assist.
How often are you
willing to correspond
with your mentee(s)?
Weekly Monthly Quarterly
I am open to a relaxed
schedule
3 | Page
Please provide in-depth answers to the following questions:
Question
Answer
Describe the
reasons for your
interest in
becoming a
mentor.
Provide
background into
your college
experience and
career path.
What
professional
offerings do you
have for our
current
students?
What do you
hope to gain
from your
engagement
with this
program?
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CAST Mentoring Program SpringSummer 2018 Professional Boundaries Statement (Fairmont State College)

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Completed 23 July 2020

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