Acknowledgment and Certification *

By applying to be a participant of the 2018-2019 PDPW Mentor Program, I am fully aware that I will be expected to fulfill the Mentor Program requirements to the best of my abilities and that my passion and interest in the program is strong and sincere.  I am also aware that applying does not guarantee me a spot in the Mentor Program and individuals will be selected upon age, dairy experience, strength of application and program interest.

The following checklist can be used as a reminder of the requirements that each selected applicant is expected to complete during the PDPW Mentor Program:

• Complete student application, resume and Disclaimer of Liability by November 10th, 2018
  • Email materials to sbrooks@pdpw.org or complete the application online at pdpw.org/mentor_program.php
    
    
• After matches have been distributed to students (November 16th), the students are responsible for contacting their mentors to schedule a time to visit
  • Thanksgiving or Winter Break
    
    
• Once the visit has been completed, students are to submit a one-page summary (where they went, what they did, what they learned, etc.), a photo taken with their mentor at the producer's farm and a signed completion form to sbrooks@pdpw.org by February 2nd, 2019
  
  
• Attend PDPW Annual Business Conference in Madison on March 13-14, 2019 at the Alliant Energy Center
  
  
• Attend PDPW Mentor Program Breakfast on March 14, 2019 at 6:45 AM at the Alliant Energy Center. It is very important that you make this event a priority!

By checking the boxes below and pressing submit, I agree to the following terms and Student disclaimer of liability.

The parties understand that the Professional Dairy Producers of Wisconsin, ("PDPW"), is acting as a facilitator of the Mentor Program, ("Program") by linking students with agricultural mentors under specified guidelines. In order to take part in the Mentor Program, the undersigned understands and agrees as follows:

Initials
1) If accepted, the Mentor agrees to attend the PDPW Annual Business Conference on March 13-14, 2019 at the Alliant Energy Center. Attendance is mandatory in order to participate in the Mentor Program.

2) The Mentor Supervisor Farm and the Mentor, as appropriate, shall be solely responsible for personal and/or physical injuries and damages incurred by either the Internship Supervisor Farm and/or the Intern.

3) The Mentor shall be solely responsible for his or her actions and completion of this Program including the duties and responsibilities required by the Internship Supervisor Farm.

4) The Mentor Supervisor Farm shall be solely responsible for compliance with any and all Federal, State and local employment, discrimination, harassment and other employment related laws, as applicable, including those provided in Paragraph 1, above.

5) Although PDPW attempts to utilize information provided to it by applicants solely for this Program, it shall not be held responsible for the outside dissemination of such information.

6) Although PDPW shall attempt to keep all information and documentation provided by it including which is posted in its website, accurate and current, it shall not be held responsible for any failures, whatsoever, to do the same.

7) In no event shall PDPW be liable to the Mentorship Farm/place of Business, Facility Advisor or the Student for any and all damages, losses and/or costs, including direct, indirect, special, incidental, consequential or punitive damages, of any kind or nature, whatsoever, relating to PDPW"s involvement in this program.

8) The Mentor's Farm or place of Business and/or the Student shall indemnify, defend and hold PDPW harmless from any and all actual or threatened causes of action, claims, damages, losses, costs, penalties, liabilities and/or deficiencies including reasonable attorney fees, of any kind or nature, including, but not limited to, lost profits, direct, indirect, incidental, consequential, special or punitive damages arising out of or relating to PDPW's involvement in this Program.

9) No oral or written information or advice given by PDPW or its authorized representatives shall, in any way whatsoever, increase the scope of this Disclaimer.

I HAVE READ AND FULLY UNDERSTAND THIS DISCLAIMER AND AGREE TO BE BOUND HEREUNDER.