Mentorship Form – Fill Out and Use This PDF

The Mentorship Evaluation Form, developed by the National Heart, Lung, and Blood Institute of the National Institutes of Health in February 2003, is a structured tool designed for trainees to assess the guidance provided by their primary or secondary mentor(s). Its questions cover a wide array of areas including intellectual growth, professional career development, academic guidance, skill development, and personal communication, aiming to foster an environment of constructive feedback and continuous improvement in mentor-mentee relationships. If you're ready to share your mentorship experiences or seek areas for development, click the button below to fill out the form.

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Mentorship Form PDF Details

At the heart of fostering intellectual growth and ensuring the success of trainees within the National Institutes of Health, particularly the National Heart, Lung, and Blood Institute, lies a comprehensive Mentorship Evaluation Form. Reviewed as recently as February 2003, this form acts as a critical bridge between mentors and their trainees, be it for a primary or secondary mentorship role. Its design facilitates a detailed appraisal across a spectrum of areas crucial to a trainee’s development ranging from intellectual growth, professional career development, academic guidance, skill development, to personal communication. Each section invites trainees to rate their mentor’s effectiveness in nurturing inventiveness, providing career counsel, offering academic advice, enhancing skills such as negotiation and presenting, and maintaining effective communication. The ratings scale from 'Disagree Strongly' to 'Agree Strongly', allowing for nuanced feedback. Comprehensive comments can be added, offering mentors insight into their performance from the perspective of those they guide. Beyond simple evaluation, the form underscores the mentors' role in modeling ethical behavior, teamwork, and work habits, ensuring the embodiment of values critical for shaping well-rounded professionals.

Question	Answer
Form Name	Mentorship Form
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	online mentors pdf no download needed, mentor questionnaire form, be my mentor form pdf, online mentor pdf

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SAMPLE: MENTORSHIP EVALUATION FORM

National Heart, Lung, and Blood Institute

National Institutes of Health

Reviewed: February 2003

To be completed by trainee for primary mentor; additional forms for secondary mentor(s) can be provided if desired.

This evaluation is for (circle one):		Primary Mentor					Secondary Mentor
Name of Mentor ______________________________________
Circle One: 1 = Disagree strongly			2 = Disagree			3 = Agree 4 = Agree strongly

Topics	Rating:						Comments (additional comments may
							be written on back of this form)

Intellectual Growth and Development

Encourages my
inventiveness including
identification of new		1	2	3	4
research topics and		1	2	3	4
research topics and
discovery of new
methodologies

Helps me develop my
capacity for theoretical		1	2	3	4
reasoning and data		1	2	3	4
reasoning and data
interpretation

Helps me to be critical
and objective concerning		1	2	3	4
my own results and ideas

Helps me become
increasingly independent
in identifying research		1	2	3	4
questions and conducting		1	2	3	4
questions and conducting
and publishing my
research

Provides constructive
feedback on my		1	2	3	4
experimental designs

Topics	Rating:				Comments (additional comments may
					be written on back of this form)

Provides thoughtful
advice on my research	1	2	3	4
progress and results

Professional Career Development

Provides counsel for
important professional	1	2	3	4
decisions

Provides opportunities for
me to meet with visiting	1	2	3	4
scientists, faculty and	1	2	3	4
scientists, faculty and
peers

Maintains balance
between supporting
his/her own research and	1	2	3	4
developing my own
career

Helps me to envision a	1	2	3	4
career plan	1	2	3	4
career plan

Provides guidance in
development and
presentation of research	1	2	3	4
projects for outside
review groups

Provides training in the
skills needed to mentor	1	2	3	4
others

Academic Guidance

Provides advice on my
coursework and academic	1	2	3	4
goals

Ensures that I am firmly
grounded in rules
regarding ethical behavior	1	2	3	4
and scientific
responsibility

Skill Development

Topics	Rating:				Comments (additional comments may
					be written on back of this form)

Helps me to work
effectively with other	1	2	3	4
individuals

Helps me to develop good	1	2	3	4
negotiating skills	1	2	3	4
negotiating skills

Provides constructive
feedback on my	1	2	3	4
presentation and writing	1	2	3	4
presentation and writing
skills

Encourages me to present
my work at scientific	1	2	3	4
meetings

Involves me in peer
review of abstracts and	1	2	3	4
manuscripts

Personal Communication

Listens carefully to my	1	2	3	4
concerns	1	2	3	4
concerns

Routinely monitors my
progress and reviews	1	2	3	4
proposed timelines and	1	2	3	4
proposed timelines and
milestones with me

Takes into account
gender, ethnic, and	1	2	3	4
cultural issues in	1	2	3	4
cultural issues in
interacting with me

Does not take advantage	1	2	3	4
of my time and abilities	1	2	3	4
of my time and abilities

Provides timely feedback	1	2	3	4

Topics	Rating:				Comments (additional comments may
					be written on back of this form)

Helps me to clarify my
responsibilities such as
contributing to team	1	2	3	4
effort, working diligently	1	2	3	4
effort, working diligently
and responding to
criticism

Is appropriately	1	2	3	4
accessible to me	1	2	3	4
accessible to me

Serves as Role Model	1	2	3	4

Conveys high ethical
standards and concern for	1	2	3	4
research subjects

Illustrates active
teamwork and	1	2	3	4
collaboration

Illustrates good mentoring	1	2	3	4
skills	1	2	3	4
skills

Illustrates good work	1	2	3	4
habits	1	2	3	4
habits

Mentorship Form – Fill Out and Use This PDF

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