Bangor Theological Seminary

Mentored Practice Learning Agreement/Covenant

Student Information:

Name:
Address:
Phone:
Email:

Mentor Information:

Name:
Address:
Phone:
Email:

Site Information:

Name of Site Supervisor: _______
Address of Site: _
Phone:
Email: ________

Brief Description of Site:

Dates of Placement: Beginning: _____________End _________________

Use extra pages/space if needed for the sections below:

Learning Goals	Objectives/Tasks (These must be concrete and measurable)	Resources Used to Attain These Goals
1.
2.
3.

Basic weekly schedule (Please indicate days and approximate hours on site. Include additional special dates agreed upon. You are expected to covenant for 10 hours a week on site (not including travel time) and 1 hour a week consultation time with Mentor.)

Vacation period agreed upon (only if applicable):

Stipend or Travel Expenses (While all stipends are at the discretion of the ministry site, the Seminary encourages the giving of stipends when feasible.

Signatures

Student __________________________________ Date__________________

Mentor __________________________________ Date__________________

MP Director ______________________________ Date__________________

Site Coordinator (if applicable) ________________________Date__________________

This learning agreement may be renegotiated by mutual consent of student and mentor.
If substantial renegotiation takes place, the director of mentored practice should receive written notice of changes made.

This agreement should not be terminated earlier than agreed upon without a joint conference between all parties who have signed this agreement.