Mentor Attestation Certification

Mentor's Name*
Please enter your name below.
First Last
Mentor's Email Address*
Mentee's First and Last Name*
Please enter the mentee's first and last name below.
Check the box below to attest that the mentee has done the following:
- Successfully completed the Long-Answer Review.
- Recorded and submitted one 30-minute coaching session and transcript with timestamps that “passes” at the PCC level.
- Completed three mentor coaching sessions.
- Coached in at least six (6) observed coaching sessions.
- Attended at least seven (7) hours of group mentoring sessions during WLCT.
Check the box to attest to Certification Completion for this Mentee*
- I attest that this mentee has completed all of the certification objectives.
Signature*
Date*
MM slash DD slash YYYY