PHENOM 2015 Evaluation

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* 1. Current contact information

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 2. If you have NCHEC credentials, provide CHES or MCHES and your number

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* 3. If you have completed mentoring activities, please describe

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* 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)

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* 5. Suggestions, comments for improving PHENOM; Changes to biosketch

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* 6. I _______ continue as a PHENOM mentor

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* 7. I would like the following documentation: