KIPBS Mentor Documentation Form

KIPBS Mentor Documentation Form ] Approved Mentor Log

Date of Proposal: ______Name of KIPBS Professional: ______Address: ______Phone: ______Email: ______

Description of KIPBS Mentor Activities: Mentors spend time supporting students as they complete the KIPBS training project. Each student needs additional support and assistance in different areas of the training. A mentor spends time on-site and/or uses phone and email correspondence to help students complete tasks associated with portfolio completion. Examples of mentoring include providing assistance in writing operational definitions, collecting interobserver agreement, brainstorming with the student when interventions are not successful, and troubleshooting issues related to both positive behavior support and person-centered planning.

Documentation of Contacts Made Date of Student’s Phone Student’s Email Hours Mentoring Name of Student Number Address Spent Activity

Note: The Training Coordinator will contact you when it is time to spend time working with a student and will specify the exact amount of time anticipated. To ensure that the time you donate working with a student is officially approved, do not spend time mentoring students without first communicating with the Training Coordinator.

KIPBS Facilitator Signature: ______

Training Coordinator Signature: ______