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* 1. Identification

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* 2. When did your meeting take place?

Date & Time

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* 3. How long did your meeting last?

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* 4. Where did the meeting take place and what was done during the meeting time? (i.e. we met for coffee at Einstein's)

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* 5. Please give a brief overview of topics discussed.

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* 6. Please provide a brief reflection of how the meeting went.

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* 7. Are there things that could be improved in order to make the next meeting for beneficial?

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* 8. Are their issues or concerns that the Mentoring Program Coordinator should follow up with this person about?

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