Camille Moss - 2021 Mentor Verification Form 1

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Northgate High School

Senior Project Mentor Verification Form

Name of Student ____Camille Moss__________________________________ Period _5_______

Mentored Project __Is there a connection between music and the mind?
___________________________________________________________________________

As a Senior Project mentor, your final responsibility is to verify completion of your student’s work and to pass
his/her project. This is due by Tuesday May 8, 2018. Mentors may write additional comments on the back of this
sheet

1. Please check if you have seen the following documents:


_X____ Your student’s Letter of Intent -- explains plans for Senior Project.
_X____ A Mentor Agreement -- explains your responsibilities.
__X___ A copy of your student’s Senior Project Research paper.

Comments: __________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

2. Please list dates you have met with student:


Date __3/6_________ Reason for Meeting
___Interview________________________________________________
Date __3/17_________ Reason for Meeting _Photo and review of project
__________________________________________________
Date ___________ Reason for Meeting ___________________________________________________

Additional meeting dates: ___________ ___________ ___________ ___________

Comments:____Excellent student and did a wonderful job on her project and


paper.________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
____________________________________________________________________________________
3. How did the project stretch or challenge the student’s abilities? Please assess the quality of the project. Please
make additional comments on the back if necessary:

We discussed how she struggled with anxiety and depression, so I found it to be quite impressive of the quality and
detail of her work. Her project is excellent and tear-jerking in my opinion.

4. Please verify that your student spent at least 20 hours on the project: Yes _X____ No _____

Mentor Name (please print) ____Susan Rancer ___________________________Signature___Susan Rancer

_________________________
Qualifications as mentor ___Music Therapist___________________________________________
Date __5/20/21_________ Telephone Number __510-654-5882________________Mentor’s Email
[email protected]________________________

THANK YOU FOR YOUR ASSISTANCE!

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