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2009 Mentor Program - Mentor Feedback Form
1
. Your Name:
Your Name:
2
. Mentee Name:
Mentee Name:
3
. How often did you meet with your mentee? (Please check one.)
How often did you meet with your mentee? (Please check one.)
Once a week
Once a month
Every three months
Every six months
Once a year
Never
Comments:
4
. What type of activities did you and your mentee participate? (Please check all that apply.)
What type of activities did you and your mentee participate? (Please check all that apply.)
Sports and entertainment events
Other
Dinner and other meals
Shadowing during rounds
Introduce to colleagues
Other
Comments:
5
. How did this mentorship meet your expectations? (Please check one.)
How did this mentorship meet your expectations? (Please check one.)
Beyond what I expected
Exactly what I expected
Less than I expected
Nothing I expected
Comments:
6
. Would you recommend this program to other physicians?
Would you recommend this program to other physicians?
Yes
No
Maybe
Why or why not? If you would like to mentor another student this year, please
register online
.
Thank you for your feedback! Questions and comments about the program can be directed to Katrina Roth, assistant director of alumni relations, at
k.roth@mmf.umn.edu
or 612-625-0336.
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