Mentor Contact Information: Louise V. Hernandez, MSN, BSN, RN, NE-BC
7207 Holder Forest Ct
713-553-0130/ 713-722-6117
Louise.hernandez@memorialhermann.org
Directions:
For Week 1, fill out the learning agreement with self-identified goals to meet course outcomes
and initial plans to meet those self-identified goals; review the goals and plans with mentor. In
Week 4 the goals, plan to meet the goals and actual goal attained is to be identified and
submitted. At Week 7 of the practicum experience, evaluate success with your mentor and
obtain the mentor’s signature at the bottom of agreement. Save this form as a Word document
and enter required information directly onto it. See Learning Agreement Grading Rubric for
grading details
The learning agreement is to be submitted Weeks 1, 4, and 7.
Learning agreement consists of three sections:
I. Student Learning Outcomes Table
II. Signatures approving plan (Week 1)
III. Signatures at mid-point (Week 4)
IV. Signatures and mentor verification (Week 7)
Note: Each section in table and signatures must be completed prior to submission for faculty
approval.
Due Dates:
1. InitialLearning Agreement is submitted by 11:59 pm MT Sunday of Week 1.
2. Mid-point evaluation and revision is submitted by 11:59 pm MT Sunday of Week 4.
3. Completed Learning Agreement is submitted by 11:59 pm MT Sunday of Week 7.
Minimum of 100 hours practicum experience required.
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