CWHHA Mentorship Program - Trainees - Assessment

This assessment should be completed at the end of the formal relationship by both the Mentor and the Mentee:

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* 1. You information:

Name

Email Address

Mentorship Start & End Dates

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* 2. I am a:

Mentor

Mentee

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* 3. Have the outcomes been achieved?

Yes

No

Partially

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* 4. Please explain why you provided the answer above.

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* 5. In your opinion, has the Mentee grown?

Yes

No

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* 6. Please explain why you provided the answer above.

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* 7. Please provide an assessment of how well each of the following aspects of the process worked (1= not well, 5 = exceptionally well).

	1	2	3	4	5
We were able to attend meetings as scheduled.	We were able to attend meetings as scheduled. 1	We were able to attend meetings as scheduled. 2	We were able to attend meetings as scheduled. 3	We were able to attend meetings as scheduled. 4	We were able to attend meetings as scheduled. 5
The environment felt safe and comfortable for sharing thoughts, ideas and opinions.	The environment felt safe and comfortable for sharing thoughts, ideas and opinions. 1	The environment felt safe and comfortable for sharing thoughts, ideas and opinions. 2	The environment felt safe and comfortable for sharing thoughts, ideas and opinions. 3	The environment felt safe and comfortable for sharing thoughts, ideas and opinions. 4	The environment felt safe and comfortable for sharing thoughts, ideas and opinions. 5
I felt my time was respected.	I felt my time was respected. 1	I felt my time was respected. 2	I felt my time was respected. 3	I felt my time was respected. 4	I felt my time was respected. 5
I feel my contributions were appreciate.	I feel my contributions were appreciate. 1	I feel my contributions were appreciate. 2	I feel my contributions were appreciate. 3	I feel my contributions were appreciate. 4	I feel my contributions were appreciate. 5
I feel the other person was prepared, organized and committed to the relationship.	I feel the other person was prepared, organized and committed to the relationship. 1	I feel the other person was prepared, organized and committed to the relationship. 2	I feel the other person was prepared, organized and committed to the relationship. 3	I feel the other person was prepared, organized and committed to the relationship. 4	I feel the other person was prepared, organized and committed to the relationship. 5
Our meetings were productive and meaningful.	Our meetings were productive and meaningful. 1	Our meetings were productive and meaningful. 2	Our meetings were productive and meaningful. 3	Our meetings were productive and meaningful. 4	Our meetings were productive and meaningful. 5
Our meetings were focused on the defined goals.	Our meetings were focused on the defined goals. 1	Our meetings were focused on the defined goals. 2	Our meetings were focused on the defined goals. 3	Our meetings were focused on the defined goals. 4	Our meetings were focused on the defined goals. 5
Challenges were addressed in a professional and constructive way.	Challenges were addressed in a professional and constructive way. 1	Challenges were addressed in a professional and constructive way. 2	Challenges were addressed in a professional and constructive way. 3	Challenges were addressed in a professional and constructive way. 4	Challenges were addressed in a professional and constructive way. 5
Privacy was respected and maintained.	Privacy was respected and maintained. 1	Privacy was respected and maintained. 2	Privacy was respected and maintained. 3	Privacy was respected and maintained. 4	Privacy was respected and maintained. 5

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* 8. Please provide any additional feedback and/or suggestions you feel would be valuable, relating to this experience.

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* 9. Would you like the Secretariat and/or someone from the Member Success Team to follow up with you regarding your survey response?

Yes

No