WiM-Virginia Mentoring Program - Final Summary Report Form

WiM-Virginia Mentoring Program - Final Summary Report Form

To be completed and submitted separately by Mentee and Mentor at the conclusion of your participation in the Mentoring Program. Please submit within 30 days of your final session. All application information will be treated confidentially and used only for program purposes.
Name *

First Name Last Name
Are you the: *

Mentor Mentee
Your input is very important and will be used to enhance our program for future participants. Please take the time to reflect on your experience and provide us with your insights. The following questions should be answered at a minimum, but please feel free to elaborate.
Please choose the option that most applies to the following statement: We have achieved our leadership growth goal(s). *

Strongly Agree Agree Neutral Disagree Strongly Disagree
Please explain: *
Please describe any addtional unanticipated breakthroughs or achievements: *
Please choose the option that most applies to the following statement: We have achieved our professional development goal(s). *

Strongly Agree Agree Neutral Disagree Strongly Disagree
What do you think are the greatest strengths of the Mentorship program? *
What do you think are significant weaknesses of the Mentorship program? *
Please consider the way that the Mentoring Program is currently structured in terms of goals, requirements, and deliverables, and comment as to how you think the program could be improved. *
Please provide any other comments you feel would facilitate the improvement of the Mentoring Program. *
Would you recommend this program to others? *

Yes No
Would you consider becoming a Mentor for this program in the future? *

Yes No
Should be Empty:

WiM-Virginia Mentoring Program - Final Summary Report Form

Your input is very important and will be used to enhance our program for future participants. Please take the time to reflect on your experience and provide us with your insights. The following questions should be answered at a minimum, but please feel free to elaborate.