Appendix A: Assessment Forms
Suggested Assessment Form for Mentees*
(Complete after first year of mentoring relationship.)
Circle the response that best suits your feeling toward the question.
The key is as follows:
1 Strongly agree 2 Agree 3 Neutral 4 Disagree 5 Strongly Disagree
I believe that mentoring is a good idea.
1 2 3 4 5
I have benefitted from the mentoring relationship.
1 2 3 4 5
My mentor is readily available.
1 2 3 4 5
We meet on a regular basis.
1 2 3 4 5
We are congruent on our goals for my professional development.
1 2 3 4 5
My mentor and I have similar values.
1 2 3 4 5
My mentor respects me as a person.
1 2 3 4 5
My mentor understands that I have a life outside of the institution and helps me to integrate my responsibilities.
1 2 3 4 5
My mentor is generous with credit.
1 2 3 4 5
My mentor has involved me in professional activities outside of this institution.
1 2 3 4 5
My mentor has involved me in committees within this institution.
1 2 3 4 5
The best things about the mentoring relationship are:
I would suggest the following improvements/modifications:
* All Assessment Forms in this appendix are adapted from University of Arkansas for the Medical Sciences The Mentor's Mentor: The Mentoring Handbook, a Guide to Mentoring.10
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