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Clinical Social Work Society of Hawaii (CSWSH)’s
MENTORSHIP PROGRAM CONTRACT
Date_____________
Participant Name_________________________________________________
Last First Middle
Residence Address: __________________________________________________________
Telephone: Home______________ Office_____________ Cell.________________
E-mail ______________________________
Agreement
The CSWSH Mentorship group will comprise no more than eight participants, and will consist of recent MSW graduates with 0-3 years of post-graduate experience. Each group session will be facilitated by one of the senior clinicians associated with the Mentorship Program. Each group will meet once a month for ten months of a calendar year. The location and time of these sessions will be determined jointly by the Mentorship group leader and the group members.
The Mentorship group leader provides a forum for recent graduates to share professional interests, enhance their skills and to expand their professional identity. It is noted that clinical supervision and psychotherapy are not components of the Mentorship program; but sharing experiences through respectful, collegial relationships are encouraged.
The Mentorship group will function as a forum for discussions about a variety of issues (i.e. job search strategies, community resources, clinical preparedness, and new experiences with clients, agencies, and supervisors); and contribute to the assessment of the developing professional needs of new CSWSH members and recent MSW graduates.
I agree to participate in the CSWSH Mentorship program per the terms stated above.
Participant ________________________________ _______________ ___________
Name Signature Date
Witness ________________________________ _______________ ___________
Name Signature Date
Mentor Group Leader ________________________________ _______________ ___________
Name Signature Date
Please return the contract together with your completed application to CSWSH, in care of:
Nicholai M. Khiterer, Psy.D., LCSW, Wai Nani Way #818, Honolulu, Hawaii 96815
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