Western Michigan University

Disability Services for Students

STATEMENT OF CONFIDENTIALITY
As an employee of Disability Services for Students, you may be
handling confidential information about our operations and the
students and patrons we serve. The people you serve have the
right to privacy, and it is your responsibility to protect that privacy.
It is our policy not to discuss confidential information outside the
work area. Some examples of this information include, but are not
limited to, social security numbers, addresses, phone numbers,
facility access information, health history/medical information,
testing results, academic progress reports.
No one is to give confidential information to media reporters,
photographers, faculty/staff, other employers or supervisors,
friends, or relatives.
No information containing confidential
information is to be duplicated or distributed outside the DSS
Department without the written consent of the individual involved.
One must refrain from having conversation about confidential
information outside the work area. Casual conversations that
include confidential information may be overheard, and thereby,
violate the privacy of others.
By signing this statement, you are confirming awareness of the
DSS statement of confidentiality and agree to follow the policy.
This statement will become part of your employee personnel file.
_____________________________________________
_______________________________________

Signature of Employee

Date

_____________________________________________
_______________________________________

Signature of Witness

Date

Employee Agreement
I understand by signing this document that I am accepting
these responsibilities and agree to the terms of
employment. I have had an opportunity to read and ask
questions about the content in the student handbook for
the Peer Mentor Program with Disability Services for
Students. I acknowledge that I am responsible for the
content and procedures in this handbook and understand
the terms for termination.

______________________________________________
_____________________________

Name (Signature)
______________________________________________

Name (Printed)

Date

Disability Services for Students

Mentor Contract

Mentoring is a process through which a desired change is

acquired.
Mentoring requires a commitment from both the mentor and the
person being mentored. Without this commitment, change cannot
occur. Regular contact and discussion must take place. The
sessions, while somewhat social, also need to be directed to a
specific topic or habit the mentee wishes to discuss. The mentor
is a guide and role model to promote positive behaviors for
success.
With this in mind, both the mentor and mentee must be willing to
be open to suggestions for how best to bring about positive
change. The more comfortable and relaxed the sessions can be,
the more open and truthful both mentor and mentee can be. The
place for these meetings is entirely up to the participants,
although neutral ground is often more appropriate. Meetings may
ONLY be held in designated areas.
I, __________________________________, agree to participate in regular
meetings with my mentee. I will meet a minimum of one day per
week for the remainder of the semester. My mentee and I may
choose to meet more often.
_____ I agree to keep the sessions to a minimum of 30 min,
preferably 60 min.
_____ I agree to focus our meetings on specific topics addressing
self-advocacy, college living and study.
_____ I am aware that the rules of student conduct will still apply.

_____ I am aware that I will have access to my mentees mid-term

academic progress report.
_____ I am aware that I will have access to my mentees academic
schedule.
_________________________________
signature

________________
date

Disability Services for Students

Mentee Contract
Mentoring is a process through which a desired change is
acquired.
Mentoring requires a commitment from both the mentor and the
person being mentored. Without this commitment, change cannot
occur. Regular contact and discussion must take place. The
sessions, while somewhat social, also need to be directed to a
specific topic or habit the mentee wishes to discuss. The mentor
is a guide and role model to promote positive behaviors for
success.
With this in mind, both the mentor and mentee must be willing to
be open to suggestions for how best to bring about positive
change. The more comfortable and relaxed the sessions can be,
the more open and truthful both mentor and mentee can be. The
place for these meetings is entirely up to the participants,
although neutral ground is often more appropriate. Meetings may
ONLY be held in designated areas.
I, __________________________________, agree to participate in regular
meetings with my mentor. I will meet a minimum of one day per
week for the remainder of the semester. My mentor and I may
choose to meet more often.
_____ I agree to keep the sessions to a minimum of 30 min.

_____ I agree to focus our meetings on specific topics addressing

college living and study.
_____ I am aware that the rules of student conduct will still apply.
_____ I am aware that my mentor will have access to my mid-term
academic progress report.
_____ I am aware that my mentor will have access to my academic
schedule.
_________________________________
signature

________________
date