Fillable Mtas Continuing Education Mentoring Form printable pdf download

MTAS Continuing Education Mentoring Form

This form should be used to document mentoring activities. Under the MTAS Continuing Education Policy and Guidelines,

mentoring or supervision is defined as an activity in which a massage therapist observes or shadows the practice of another health

professional in order to obtain a better understanding of other modalities or to learn new techniques. A copy of all completed

mentoring forms should be submitted at the end of each year.

1 primary CEU per 2 hours of shadowing.

[

Note that an equal number of credits are awarded to both the mentor (if an MTAS member) and the shadowing therapist].

Member Name: ________________________________________

Membership Number: __________________

Address: _____________________________________________

City: ________________________________

Postal Code: ________________

Tel: ________________

E-mail: ______________________________

Mentor’s Name: ________________________________________

Mentor’s Qualifications (profession, credentials, number of years of training, number of years in practice): __________

________________________________________________________________________________________________

Please ensure that there is a confidentiality agreement in place between you and the

mentor, and that client consent is obtained.

Massage Therapist: please write below a brief description of your observations and learning experiences (additional

paper or the back of this form may be used as necessary).

________________________________________________________________________________________________

Mentor’s signature: ___________________________________

Date: _______________________________

Therapist signature: ___________________________________

Total hours of mentoring: _______________

Please note that signing or issuing, in your professional capacity, a document that you know contains false or misleading

statements is a matter of professional misconduct and will be referred to the Disciplinary Committee if deemed necessary.

Please submit copies of all documentation to the MTAS office and allow up to 8 weeks for

completion of the evaluation process.

________________________________________________________________________________________________

Massage Therapist Association of Saskatchewan Inc., #16 - 1724 Quebec Avenue, Saskatoon, Sask. S7K 1V9

Tel: 306-384-7077

Fax: 306-384-7175

E-mail:

mtas@sasktel.net

H:\Continuing Education\Con Ed Forms\Mentoring form.doc

Mtas Continuing Education Mentoring Form