<p> International Association for Impact Assessment South Africa</p><p>ISMP MENTOR APPLICATION PERSON DETAILS First Name: Last Name: Title (Mr/Ms/Mrs/Dr): ID number: Phone number: Email Address: WORK DETAILS Job Title: Company Name:</p><p>Work Physical Address:</p><p>AGREEMENT I,...... (mentor's name), ……………………………. (ID Number), the undersigned, hereby agree to mentor a postgraduate student through the IAIAsa Student Mentorship Programme ("ISMP") and I confirm that I have my employer's permission to do so. As mentor, I will provide the student at least 80 hours of mentorship within the ISMP 2017 period (01 March 2017 to 30 November 2017). I am aware that I will be participating in the ISMP 2017 on a voluntary basis and payment to the student is not mandatory. I will expose the student to as many areas of my work as possible, including field- and office-based work and will provide him or her with the necessary tools, information, guidance and assistance to complete the tasks I’ll set. I undertake not to place the burden and responsibility of my work on the student and allow the mentorship to come in the way of his or her studies. Unless I clearly state otherwise in writing to the IAIAsa NEC, I will avail myself to be a referee to my student in his/her CV. I commit to taking all necessary precaution to ensure that I do not expose my student to prejudice, loss, damage, illness or injury during the ISMP. I am aware that neither myself nor my company is obliged to provide employment to the student after he / she has completed the ISMP 2017. I understand that the IAIAsa NEC can terminate the mentorship in writing at any time, with immediate effect, should it find it fitting, with or without my consultation. I hereby indemnify IAIAsa and the student from any loss or injury that I or my company may suffer as a result of my participation in the ISMP. </p><p>Signed at ...... on ...... of ...... 2016.</p><p>______(mentor signature)</p><p>Signed at ...... on ...... of ...... 2016.</p><p>______(employer signature)</p>