Mentorship Form – Fill Out and Use This PDF

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

discovery of new

methodologies

Helps me develop my

capacity for theoretical

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

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

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

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

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

Provides constructive

feedback on my

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

Routinely monitors my

progress and reviews

1

2

3

4

proposed timelines and

milestones with me

Takes into account

gender, ethnic, and

1

2

3

4

cultural issues in

interacting with me

Does not take advantage

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

and responding to

criticism

Is appropriately

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

Illustrates good work

1

2

3

4

habits