NCME Mentee Questionnaire

Please respond to each of the following questions based on how much progress you feel that you and your mentor have made up to this point in the program. Please choose the appropriate response.

Quarter for which you are reporting:

Year:

State:

First Name:

Last Name:

Mentor's first name:

Mentor's last name:

1. On a scale of 1= completely negative to 10= completely positive, would you say that your experiences in the mentoring relationship so far have been mostly positive, or mostly negative?

2. On a scale of 1= not at all to 10= a great amount, how much respect do you feel that your mentor has shown towards the decisions you have made?

3. On a scale of 1= not at all to 10= a great amount, have you felt valued by, or important to your mentor?

4. On a scale of 1= not at all safe to 10= very safe, how safe do you feel sharing personal thoughts with your mentor?

5. On a scale of 1= not at all to 10= a great deal; do you feel a sense of belonging, or a connection with your mentor?

6. On a scale of 1= not at all to 10= a great amount, do you feel that this mentoring relationship is helping you make progress toward achieving your personal goals?

7. What, if any, have been barriers to you and your mentor meeting by telephone or in person? (1,000 characters max)

8. What do you enjoy most about having a mentor? (1,000 characters max)

9. What do you enjoy least about having a mentor? (1,000 characters max)

10. Is there anything that you would like to change about the visits you have with your mentor? (1,000 characters max)

Additional comments:

Thank you for your response!