School of Nursing & Midwifery

MENTORSHIP ASSESSMENT DOCUMENT

Student mentor’s Name:
(Block Capitals)

Keele ID Number:
(First 8 digits from Keele Card)

Module Code:

NUR-30186

Workplace Name: Module Start & Finish Dates: Supervisor’s Name:
(Block Capitals)

Personal Tutor:
(Block Capitals)

Start:

Finish:

Module Leader:
(Block Capitals)

Assessment Submission Date: Assessment Result: For MIDWIFERY STUDENTS ONLY, the assessment decision also includes sign-off

Date of Supervisor’s Last Update: PASS
(Supervisor – please delete above as appropriate)

FAIL
(Supervisor – please delete above as appropriate)

Assessment date:

Please download and save this file with your own name as part of the file name Student mentors MUST keep and back-up copies of this document as it must be submitted to the School by email as part of the module’s summative assessment strategy.
1 C:\Users\NATHAN\AppData\Local\Microsoft\Windows\Temporary Internet Files\Low\Content.IE5\GJVPHQF6\NUR%20%2030186%20Mentorship%20Assessment%20Document%20SEPTEMBER%202014[1].rtf

Introduction This booklet contains the necessary documentation for recording whether or not a student mentor has demonstrated achievement of the competencies for this module. The following details provide guidance for student mentors, supervisors, link lecturers and tutorial staff on the assessment of student mentors during the module. The document is to be completed electronically by the student mentor and their supervisor. It is important to keep back-up copies of the document and that the filename contains the student mentor’s first name and surname.

Terminology For ease of reference, the following terms are used in this and other documentation on this module.    Student mentor – the professionally registered person undertaking the module and wishing to become a mentor Supervisor –