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Confidentiality Statement

As part of my participation in the DREAMS First Year Mentoring Program at Morehead State University, I, the mentor, hereby enter into this Agreement with the student(s), the mentee, participating in the DREAMS Mentoring and Leadership Program and as such agree as follows:

I shall not, except as authorized by my assigned student(s), at any time during or after our participation in the DREAMS First Year Mentoring Program disclose to any other person or entity other than the DREAMS staff any proprietary, confidential, or sensitive information of or pertaining to them (collectively called “Confidential Information”), which has to come into my possession, custody or knowledge during the course of the mentoring and other program activities; nor shall I use any such Confidential Information for my personal use or advantage or make it available to others. I will not disclose or use, directly or indirectly, any Confidential Information, or make such Confidential Information available to others for use in any way.

There are four conditions under which DREAMS mentors may breach confidentiality:

  1. Student poses an imminent risk of doing serious harm to self;
  2. Student poses an imminent risk of doing harm to others;
  3. Student is a victim of physical or sexual abuse;
  4. Mandated by a judge in a court of law;

Confidential Information includes: information related to a student’s disability, academic performance, and/or family information.

By checking this box, I agree to the terms of confidentiality explained above:*