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Confidentiality and Disclosure Statement

[Download editable version of this form.]

This disclosure statement will provide you with information about the Mentor Program.

Purpose

The purpose of the mentor program is to provide aspiring leaders with senior-level partners to offer guidance, share experiences, suggest resources and impart knowledge through personal and professional development.

Participation in mentoring programs has many benefits. These benefits extend from multiculturalism, identification of common values, immediate feedback, and overall organization support. In defining or redefining self-awareness, participants are encouraged to explore the possibility of ridding emotional stressors that interfere with human normalcy. Adopting new lifestyles or alternative ways of thinking (i.e., perceived optimism) has proven to be successful in alleviating impediments to goals and blockages to perceived organizational strategies.

Confidentiality Statement

As a participant of the HHS office of acquisition workforce and strategic initiatives (OAWSI) mentor program, I agree to maintain the utmost discretion and confidentiality of all personal, professional, and contact information given to me about my mentoring connections. Anything that is discussed during my mentor/mentee meetings will be held in the strictest of confidence and will, under no circumstances, be shared with any persons outside of the session. This information from any source and in any form, including, but not limited to, paper record, oral communication, audio recording, and electronic display, is strictly confidential and should not be shared with others, regardless of whether they are in the program.  However, state regulations and federal government does require me to reveal any information that depicts harm to self, harm to others, and or any form of child abuse. This is an ethical and legal principle that we must abide by. Breaches of this agreement may result in forfeiture of program participation and your mentoring partnership.

 

 

 

Participant Signature: _______________________

Date: ________

Participant Name: ____________________

Title: _______________________

 

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