Appendix A: Assessment Forms

Suggested Assessment Form for Mentors*

(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 think mentoring is a good idea.
  1     2     3     4     5

• I believe that my mentee has benefited from the relationship.
  1     2     3     4     5

• I have personally benefited from the relationship.
  1     2     3     4     5

• My mentee and I have similar values.
  1     2     3     4     5

• My mentee respects me as a person.
  1     2     3     4     5

• The relationship requires too much of my time.
  1     2     3     4     5

• I have the support of my department/division chair for my mentoring activities.
  1     2     3     4     5

• I have referred my mentee to other faculty for help in a specific area.
  1     2     3     4     5

• My mentee doesn't really need a mentor.
  1     2     3     4     5

The best thing about mentoring is:

I would suggest the following changes/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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