PHENOM 2017 Evaluation Question Title * 1. Current contact information Name Company Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Question Title * 2. If you have NCHEC credentials, provide CHES or MCHES and your number Question Title * 3. If you have completed mentoring activities, please describe Question Title * 4. Evaluate the following statements: Strongly Disagree Disagree Neither Disagree Nor Agree Agree Strongly Agree PHENOM is an important service program PHENOM is an important service program Strongly Disagree PHENOM is an important service program Disagree PHENOM is an important service program Neither Disagree Nor Agree PHENOM is an important service program Agree PHENOM is an important service program Strongly Agree PHENOM is beneficial to those looking for career direction PHENOM is beneficial to those looking for career direction Strongly Disagree PHENOM is beneficial to those looking for career direction Disagree PHENOM is beneficial to those looking for career direction Neither Disagree Nor Agree PHENOM is beneficial to those looking for career direction Agree PHENOM is beneficial to those looking for career direction Strongly Agree PHENOM has allowed me to share my professional expertise in a meaningful way PHENOM has allowed me to share my professional expertise in a meaningful way Strongly Disagree PHENOM has allowed me to share my professional expertise in a meaningful way Disagree PHENOM has allowed me to share my professional expertise in a meaningful way Neither Disagree Nor Agree PHENOM has allowed me to share my professional expertise in a meaningful way Agree PHENOM has allowed me to share my professional expertise in a meaningful way Strongly Agree Other (please specify) Question Title * 5. Suggestions, comments for improving PHENOM; Changes to biosketch Question Title * 6. I _______ continue as a PHENOM mentor Will Wil not Question Title * 7. I would like the following documentation: A Certificate of Appreciation Proof of Mentoring Service for Category II CECH (meeting all requirements) Both Done